Treatment of cd47+ disease cells with sirp alpha-fc fusions

ABSTRACT

CD47+ disease cells, such as CD47+ cancer cells, are treated with an agent that blocks signalling via the SIRPα/CD47 axis. The agent is a human SIRPα fusion protein that displays negligible CD47 agonism and negligible red blood cell binding. The fusion protein comprises an IgV domain from variant 2 of human SIRPα, and an Fc having effector function. The IgV domain binds human CD47 with an affinity that is at least five fold greater than the affinity of the entire extracellular region of human SIRPα. The fusion protein is at least 5 fold more potent than a counterpart lacking effector function.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/653,165 filed Jun. 17, 2015, which is a national phase applicationunder 35 U.S.C. § 371 of International Application No. PCT/CA2013/001046filed 17 Dec. 2013, which claims priority to U.S. ProvisionalApplication No. 61/738,008 filed 17 Dec. 2012. The entire contents ofeach of the above-referenced disclosures is specifically incorporated byreference herein without disclaimer.

FIELD OF THE INVENTION

This invention relates to therapeutic, Fc fusion proteins usefulparticularly for the treatment of subjects presenting with CD47+ diseasecells. The fusion proteins are based on a domain within theextracellular region of human SIRPα, and incorporate an Fc region thatenhances the anti-cancer effect of the fusion protein.

BACKGROUND TO THE INVENTION

Signal regulatory protein alpha (SIRPα) is a transmembrane proteinbelonging to the immunoglobulin superfamily, and a receptor for CD47.Cloning and expression of a human form of SIRPα has been described byUllrich et al in U.S. Pat. No. 6,541,615. Involvement of SIRPα and CD47in the etiology of cancer and other diseases has been implicated bySarfati et al in WO1999/040940 and by Van den Berg et al in WO00/66159,who suggest therapeutic use of an inhibitor of SIRPα. More recently,Jaiswal et al have suggested the use of antibodies to CD47 for thetreatment of hematopoietic cancers, in WO2009/091601. The interactionbetween SIRPα and CD47 plays an important role in regulating thephagocytosis of leukemia cells and leukemia stem cells (LSCs) bymacrophages. Blocking antibodies against CD47 have been shown to promotephagocytosis of LSCs by macrophages. In addition, Wang et al havesuggested cancer treatments based on SIRPα fusion proteins in WO2010/130053. For treating immune disorders, Smith et al have suggestedthe use of CD47-based Fc fusions, in US2008/0131431. The treatment ofinflammatory and immune disorders also is taught by Raymond et al, inWO2010/070047.

It would be useful to provide agents that inhibit signalling via theSIRPα/CD47 axis for use in the treatment of cancer and other diseases.

SUMMARY OF THE INVENTION

The present invention provides SIRPα as an Fc fusion protein in whichcomponents are selected for optimal inhibition of the CD47/SIRPα axis.The present inventors have found that a particular and singular domainwithin the extracellular region of human SIRPα binds CD47 with greateraffinity than the intact extracellular region of human SIRPα. Also, itis demonstrated herein that in vivo efficacy of SIRPαFc fusions issurprisingly and dramatically improved when the constant (Fc) region isone having effector function, notwithstanding that inhibition of theCD47/SIRPα axis should require no such activity, and despite in vitroindications that an effectorless Fc region should be preferred.

The present SIRPαFc fusion proteins also demonstrate negligible CD47agonism, permitting them to act as a dedicated inhibitor ofSIRPα-mediated signalling in vivo. As a further attribute, the fusionprotein exhibits negligible binding to red blood cells. This is in sharpcontrast to other inhibitors of this axis, such as CD47 antibodies, thatbind strongly to red blood cells, in some instances causinghemagglutination. With the present fusion protein, dosing does not needto account for the “sink” effect in which administered drug becomessequestered and inactive in RBC-bound form, or to account for anyadverse events caused by RBC interaction.

In one of its aspects, there is provided a SIRPαFc fusion protein usefulto inhibit SIRPα-mediated stimulation of cell-bound CD47, the fusionprotein comprising a SIRPα protein component and, fused therewith, anantibody constant region (Fc) component, wherein the SIRPα proteincomponent consists of or comprises the V domain of human SIRPα and theFc component is the constant region of an IgG having effector function.In embodiments, the Fc is selected from the constant region of an IgG1antibody or an IgG4 antibody.

In a related aspect, there is provided a polynucleotide that encodes asecretable form of the SIRPαFc fusion as a single chain polypeptide. Inanother related aspect, there is provided a cellular host useful toproduce the SIRPαFc fusion protein, the host having the polynucleotideincorporated expressibly therein. As well, in another embodiment, thereis provided a method for obtaining the SIRPαFc fusion protein,comprising culturing or growing the host, and recovering the SIRPαFcfusion as a dimeric protein. In embodiments, the host is a eukaryotichost of any species that glycosylates expressed proteins.

In another of its aspects, the present invention provides apharmaceutical composition useful to treat a subject presenting with adisease cell that is CD47+, the composition comprising apharmaceutically acceptable carrier and an amount of the SIRPαFc fusionprotein effective to inhibit the growth or proliferation of the CD47+disease cell.

In a further aspect, the present invention provides a method fortreating a subject presenting with CD47+ disease cells, the methodcomprising administering to the subject an amount of the SIRPαFc fusionprotein effective to inhibit the growth and/or proliferation of thedisease cells. In a related aspect, the present invention provides forthe use of the SIRPαFc protein to treat cancer or any other disease inwhich CD47+ disease cells are present. There is also provided the use ofthe SIRPαFc protein for the manufacture of a medicament for thetreatment of cancer or another disease in which CD47+ disease cells arepresent. Similarly, there is provided a pharmaceutical composition foruse in treating a CD47+ disease cell, comprising the SIRPα-Fc proteinand a pharmaceutically acceptable carrier. In embodiments, the diseasecells are CD47+ cancer cells, particularly including CD47+ leukemiacells, such as AML.

These and other aspects of the present invention are now described ingreater detail with reference to the accompanying drawings, in which:

REFERENCE TO THE FIGURES

FIG. 1 compares the binding of SIRPα fusions designated TTI-602 andTTI-616 to human CD47 using a direct binding assay (FIG. 1A) and anindirect competition assay (FIG. 1B). More particularly, the binding ofSIRPαFc with a single N-terminal SIRPα V-domain (TTI-616) was comparedto a fusion consisting of all three (V-C-C) extracellular SIRPα domains(TTI-602). A) Direct binding assay. CD47+ human Jurkat T cells wereincubated with titrated amounts of TTI-602 or TTI-616 and bindinganalyzed by flow cytometry using a polyclonal anti-IgG antibody. B)Competitive inhibition assay. Jurkat cells were incubated withbiotinylated SIRPαFc (TTI-601) in the presence of titrated amounts ofcold competitor TTI-602 or TTI-616. Binding was measured by flowcytometry, and the results converted to percentage inhibition, with 0%defined as binding in the absence of competitor.

FIG. 2 shows binding profiles (Kd) for three different SIRPα fusionproteins. Revealed are very similar binding profiles, producing nearlyidentical affinity binding (Kd) values (2.3-2.4 nM). This was expected,as all three proteins contain the same SIRPα region and the Fc regionwas not predicted to affect ligand binding. More particularly, CD47+human Jurkat T cells were incubated with titrated amounts of fusionproteins and binding analyzed by flow cytometry using a polyclonalanti-IgG antibody. The geometric means were then normalized and thebinding curves and Kd values were generated by Prism (Graphpad) usingnonlinear regression fitting the data to a one site binding model.

FIG. 3 (see also FIG. 6) shows that TTI-621 and TTI-622 exhibit similarpro-phagocytosis activity, whereas TTI-616 is clearly weaker (this isparticularly evident at the 10 nM dose). This indicates either a wildtype IgG4 or IgG1Fc region is required for maximal SIRPαFc-triggeredtumor cell killing by macrophages. More particularly, macrophages weregenerated by culturing human peripheral blood CD14+ monocytes for atleast 1 week in the presence of monocyte colony stimulating factor, andthen activated with interferon-gamma (overnight) and LPS (1 hour).OCI/AML-2 cells were labeled with CFSE and incubated for 30 minutes withSIRPαFc fusions at the indicated concentrations or control Fc proteins(mutated hIgG4 Fc (TTI-401) or hIgG1 Fc (TTI-402)) at 1 mM or leftuntreated (UT). The AML-2 cells and macrophages were then co-culturedfor 2 hours, and the macrophages were stained with wheat germ agglutininAlexa Fluor® 555 conjugate and analyzed by confocal microscopy. Thephagocytosis index is defined as the number of AML cells engulfed per100 macrophages, counting at least 200 macrophages per sample. Fusionproteins with a mutated hIgG4 Fc region are shown as white bars, wildtype hIgG4 as grey bars and wild type IgG1 as black bars. **p<0.05,*p<0.01 vs. isotype control (one-way ANOVA and Dunnett's post-test).

FIG. 4 shows that the TTI-621 fusion protein bearing an IgG1 Fc regionwas the only protein capable of mediating an anti-leukemic effect at thesite of transplantation (the injected femur). In the non-injected bonemarrow, there was a clear Fc dependent effect, with TTI-621 (full Fcactivity) >TTI-622 (low Fc activity) >TTI-616 (no Fc activity).NOD/ShiLtJ-Prkdc^(scid) (NOD.SCID) mice (8-12 weeks old) weresublethally irradiated with 275 cGy from a 137Cs g-irradiator andtreated with anti-CD122 antibody (to deplete NK cells) prior tointrafemoral injection of AML cells collected from a human leukemiapatient. Starting three weeks after transplantation, mice were treatedwith SIRPαFc fusion proteins (8 mg/kg IP three times per week) orequimolar doses of control Fc proteins TTI-401 (mutated human IgG4) orTTI-402 (human IgG1). After 4 weeks of treatment, mice were sacrificedand human leukemia cells in the injected femur, non-injected bone marrowand spleen detected by flow cytometric analysis, staining for expressionof human CD45 and human CD33 markers. The AML engraftment was expressedas the percentage of human CD45+CD33+ cells in each compartment.

FIG. 5 CD47+ human Jurkat T cells were incubated with SIRPαFc fusionproteins or control Fc (3 μM) or left untreated (UT) overnight and thenstained for Annexin-V and analyzed by flow cytometry. The pro-apoptoticagent staurosporine (Staur) at 1 mM was included as a positive control.One sample containing TTI-602 was pretreated with B6H12, a CD47-blockingantibody.

FIG. 6 shows results obtained using the protocols described for FIG. 3,but with a more developed data set.

FIG. 7 A) Human erythrocytes were stained with titrated amounts of theanti-CD47 antibody B6H12 or TTI-616 and analyzed by flow cytometry. B)Human erythrocytes were stained with a panel of anti-CD47 monoclonals(2D3, B6H12, BRIC126 and CC2C6) or SIRPαFc fusion protein TTI-622 andanalyzed by flow cytometry. Each reagent was used at a saturatingconcentration identified in previous optimization experiments. TTI-401was used as a control Fc. Data shown are pooled from six donors. C)AML-2 tumor cells were stained with CD47 antibodies or TTI-622 andanalyzed by flow cytometry. Data are shown for a single high dose (660nM) of each reagent.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to the human SIRPα protein, in a formfused directly or indirectly with an antibody constant region, or Fc.Unless otherwise stated, the term “human SIRPα” as used herein refers toa wild type, endogenous, mature form of human SIRPα. In humans, theSIRPα protein is found in two major forms. One form, the variant 1 or V1form, has the amino acid sequence set out as NCBI RefSeq NP_542970.1(residues 27-504 constitute the mature form). Another form, the variant2 or V2 form, differs by 13 amino acids and has the amino acid sequenceset out in GenBank as CAA71403.1 (residues 30-504 constitute the matureform).

These two forms of SIRPα constitute about 80% of the forms of SIRPαpresent in humans, and both are embraced herein by the term “humanSIRPα”. Also embraced by the term “human SIRPα” are the minor formsthereof that are endogenous to humans and have the same property oftriggering signal transduction through CD47 upon binding thereto. Thepresent invention is directed most particularly to the variant 2 form,or V2.

The present SIRPαFc fusion proteins incorporate one of the threeso-called immunoglobulin (Ig) domains that lie within the extracellularregion of human SIRPα. More particularly, the present SIRPαFc proteinsincorporate residues 32-137 of human SIRPα (a 106-mer), which constituteand define the IgV domain of the V2 form according to currentnomenclature. This SIRPα sequence, shown below, is referenced herein asSEQ ID No.1.

[SEQ ID No. 1] EELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENIVIDFSISISNITPADAGTYYCVKFRKGSP DTEFKSGA

In a preferred embodiment, the SIRPαFc fusion proteins incorporate theIgV domain as defined by SEQ ID No.1, and additional, flanking residuescontiguous within the SIRPα sequence. This preferred form of the IgVdomain, represented by residues 31-148 of the V2 form of human SIRPα, isa 118-mer having SEQ ID No. 22 shown below:

[SEQ ID No. 22] EEELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPD TEFKSGAGTELSVRAKPS

It has been found that the activity of this V2 form of human SIRPα issurprisingly greater, in terms of CD47 binding affinity, relative to theCD47 binding affinity of the entire extracellular domain of SIRPα. Thisbinding affinity is at least two fold greater than the binding affinityof the entire extracellular domain. In embodiments, the affinity is atleast 3 fold, 4 fold, 5 fold or greater for the V2 domain relative tothe entire extracellular domain. In a direct binding assay, as reportedin Example 1 herein, a fusion protein that incorporates this SIRPαdomain has a binding affinity approximately 10-fold greater than afusion protein that incorporates the entire SIRPα extracellular domain.Likewise, in an indirect competition assay also reported in Example 1herein, the V2/IgV single-domain fusion provides a binding affinity thatis superior to the CD47 binding affinity of a fusion that incorporatesthe entire extracellular region of SIRPα. Accordingly, SIRPαFc fusionsbased on this preferred V domain have the potential for greater potencyin inhibiting the CD47 signalling that is stimulated upon binding withSIRPα.

The present SIRPα fusion proteins also incorporate an Fc region havingeffector function. The preference for effector function is entirelysurprising, and difficult to explain with current information regardingthe CD47/SIRPα axis. It could be expected that an effectorless Fc regionwould have activity sufficient to inhibit this axis, and that nothingmore would be gained by integrating effector function. Nevertheless, thedata herein as presented particularly in Example 5 show clearly that abenefit attaches to an effector-active Fc, in terms of the anti-leukemicin vivo activity of the fusion. This is particularly surprising in lightof the results shown in Example 4, where the phagocytic activity of thefusion appears in vitro to show no particular preference for fusionsbased on either effector-active or effectorless Fc components.

For use in the present SIRPαFc fusion s, suitable Fc components thus arethose having effector function. An Fc component “having effectorfunction” is an Fc component having at least some effector function,such as at least some contribution to antibody-dependent cellularcytotoxicity or some ability to fix complement. Also, the Fc will atleast bind to Fc receptors. These properties can be revealed usingassays established for this purpose. Functional assays include thestandard chromium release assay that detects target cell lysis. By thisdefinition, an Fc region that is wild type IgG1 or IgG4 has effectorfunction, whereas the Fc region of a human IgG4 mutated to eliminateeffector function, such as by incorporation of an alteration series thatincludes Pro233, Val234, Ala235 and deletion of Gly236 (EU), isconsidered not to have effector function. In a preferred embodiment, theFc is based on human antibodies of the IgG1 isotype. The Fc region ofthese antibodies will be readily identifiable to those skilled in theart. In embodiments, the Fc region includes the lower hinge-CH2-CH3domains.

In a specific embodiment, the Fc region is based on the amino acidsequence of a human IgG1 set out as P01857 in UniProtKB/Swiss-Prot,residues 104-330, and has the amino acid sequence shown below andreferenced herein as SEQ ID No.2:

[SEQ ID No. 2] DKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK*

Thus, in embodiments, the Fc region has either a wild type or consensussequence of an IgG1 constant region. In alternative embodiments, the Fcregion incorporated in the fusion protein is derived from any IgG1antibody having a typical effector-active constant region. The sequencesof such Fc regions can correspond, for example, with the Fc regions ofany of the following IgG1 sequences (all referenced from GenBank), forexample: BAG65283 (residues 242-473), BAC04226.1 (residues 247-478),BAC05014.1 (residues 240-471), CAC20454.1 (residues 99-320), BAC05016.1(residues 238-469), BAC85350.1 (residues 243-474), BAC85529.1 (residues244-475), and BAC85429.1 (residues (238-469).

In other embodiments, the Fc region has a sequence of a wild type humanIgG4 constant region. In alternative embodiments, the Fc regionincorporated in the fusion protein is derived from any IgG4 antibodyhaving a constant region with effector activity that is present but,naturally, is significantly less potent than the IgG1 Fc region. Thesequences of such Fc regions can correspond, for example, with the Fcregions of any of the following IgG4 sequences: P01861 (residues 99-327)from UniProtKB/Swiss-Prot and CAC20457.1 (residues 99-327) from GenBank.

In a specific embodiment, the Fc region is based on the amino acidsequence of a human IgG4 set out as P01861 in UniProtKB/Swiss-Prot,residues 99-327, and has the amino acid sequence shown below andreferenced herein as SEQ ID No.23:

[SEQ ID No. 23] ESKYGPPCPSCPAPEFLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK

In embodiments, the Fc region incorporates one or more alterations,usually not more than about 5 such alterations, including amino acidsubstitutions that affect certain Fc properties. In one specific andpreferred embodiment, the Fc region incorporates an alteration atposition 228 (EU numbering), in which the serine at this position issubstituted by a proline (S²²⁸P), thereby to stabilize the disulfidelinkage within the Fc dimer. Other alterations within the Fc region caninclude substitutions that alter glycosylation, such as substitution ofAsn²⁹⁷ by glycine or alanine; half-life enhancing alterations such asT²⁵²L, T²⁵³S, and T²⁵⁶F as taught in U.S. 62/777,375, and many others.Particularly useful are those alterations that enhance Fc propertieswhile remaining silent with respect to conformation, e.g., retaining Fcreceptor binding.

In a specific embodiment, and in the case where the Fc component is anIgG4 Fc, the Fc incorporates at least the S²²⁸P mutation, and has theamino acid sequence set out below and referenced herein as SEQ ID No.24:

[SEQ ID No. 24] ESKYGPPCPPCPAPEFLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK

The present invention thus provides a fusion protein useful to inhibitthe binding of human SIRPα and human CD47, thereby to inhibit or reducetransmission of the signal mediated via SIRPα-bound CD47, the fusionprotein comprising a human SIRPα component and, fused therewith, an Fccomponent, wherein the SIRPα component comprises or consists of a singleIgV domain of human SIRPα V2 and the Fc component is the constant regionof a human IgG having effector function.

In one embodiment, the fusion protein comprises a SIRPα componentconsisting at least of residues 32-137 of the V2 form of wild type humanSIRPα, i.e., SEQ ID No.1. In a preferred embodiment, the SIRPα componentconsists of residues 31-148 of the V2 form of human SIRPα, i.e., SEQ IDNo. 22. In another embodiment, the Fc component is the Fc component ofthe human IgG1 designated P01857, and in a specific embodiment has theamino acid sequence that incorporates the lower hinge-CH2-CH3 regionthereof i.e., SEQ ID No.2.

In a preferred embodiment, therefore, the present invention provides aSIRPαFc fusion protein, as both an expressed single chain polypeptideand as a secreted dimeric fusion thereof, wherein the fusion proteinincorporates a SIRPα component having SEQ ID No.1 and preferably SEQ IDNo, 22 and, fused therewith, an Fc region having effector function andhaving SEQ ID No.2. When the SIRPα component is SEQ ID No. 1, thisfusion protein comprises SEQ ID No.3, shown below:

[SEQ ID No. 3] EEELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPSDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK*

When the SIRPα component is SEQ ID No. 22, this fusion protein comprisesSEQ ID No. 25, shown below:

[SEQ ID No. 25] EEELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPSDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK

In alternative embodiments, the Fc component of the fusion protein isbased on an IgG4, and preferably an IgG4 that incorporates the S²²⁸Pmutation. In the case where the fusion protein incorporates thepreferred SIRPα IgV domain of SEQ ID No.22, the resulting IgG4-basedSIRPα-Fc protein has SEQ ID No. 26, shown below:

[SEQ ID No. 26] EEELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPSESKYGPPCPPCPAPEFLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK

In preferred embodiments of the invention, the fusion protein comprises,as the SIRPα IgV domain of the fusion protein, a sequence that is SEQ IDNo.22. The preferred SIRPαFc is SEQ ID No.25.

In the SIRPαFc fusion protein, the SIRPα component and the Fc componentare fused, either directly or indirectly, to provide a single chainpolypeptide that is ultimately produced as a dimer in which the singlechain polypeptides are coupled through intrachain disulfide bonds formedwithin the Fc region. The nature of the fusing region is not critical.The fusion may be direct between the two components, with the SIRPcomponent constituting the N-terminal end of the fusion and the Fccomponent constituting the C-terminal end. Alternatively, the fusion maybe indirect, through a linker comprised of one or more amino acids,desirably genetically encoded amino acids, such as two, three, four,five, six, seven, eight, nine or ten amino acids, or any number of aminoacids between 5 and 100 amino acids, such as between 5 and 50, 5 and 30or 5 and 20 amino acids. A linker may comprise a peptide that is encodedby DNA constituting a restriction site, such as a BamHI, ClaI, EcoRI,HindIII, PstI, SalI and XhoI site and the like.

The linker amino acids typically and desirably will provide someflexibility to allow the Fc and the SIRP components to adopt theiractive conformations. Residues that allow for such flexibility typicallyare Gly, Asn and Ser, so that virtually any combination of theseresidues (and particularly Gly and Ser) within a linker is likely toprovide the desired linking effect. In one example, such a linker isbased on the so-called G₄S sequence (Gly-Gly-Gly-Gly-Ser) which mayrepeat as (G₄S)_(n) where n is 1, 2, 3 or more, or is based on (Gly)n,(Ser)n, (Ser-Gly)n or (Gly-Ser)n and the like. In another embodiment,the linker is GTELSVRAKPS (SEQ ID No.21). This sequence constitutesSIRPα sequence that C-terminally flanks the IgV domain (it beingunderstood that this flanking sequence could be considered either alinker or a different form of the IgV domain when coupled with the IgVminimal sequence described above). It is necessary only that the fusingregion or linker permits the components to adopt their activeconformations, and this can be achieved by any form of linker useful inthe art.

The SIRPαFc fusion is useful to inhibit interaction between SIRPα andCD47, thereby to block signalling across this axis. Stimulation of SIRPαon macrophages by CD47 is known to inhibit macrophage-mediatedphagocytosis by deactivating myosin-II and the contractile cytoskeletalactivity involved in pulling a target into a macrophage. Activation ofthis cascade is therefore important for the survival of CD47+ diseasecells, and blocking this pathway enables macrophages to eradicate theCD47+ disease cell population.

The term “CD47+” is used with reference to the phenotype of cellstargeted for binding by the present polypeptides. Cells that are CD47+can be identified by flow cytometry using CD47 antibody as the affinityligand. CD47 antibodies that are labeled appropriately are availablecommercially for this use (for example, clone B6H12 is available fromSanta Cruz Biotechnology). The cells examined for CD47 phenotype caninclude standard tumour biopsy samples including particularly bloodsamples taken from the subject suspected of harbouring endogenous CD47+cancer cells. CD47 disease cells of particular interest as targets fortherapy with the present fusion proteins are those that “over-express”CD47. These CD47+ cells typically are disease cells, and present CD47 ata density on their surface that exceeds the normal CD47 density for acell of a given type. CD47 overexpression will vary across differentcell types, but is meant herein to refer to any CD47 level that isdetermined, for instance by flow cytometry as exemplified herein or byimmunostaining or by gene expression analysis or the like, to be greaterthan the level measurable on a counterpart cell having a CD47 phenotypethat is normal for that cell type.

Accordingly, for therapeutic use, there is provided a pharmaceuticalcomposition comprising a pharmaceutically acceptable carrier, and atherapeutically effective amount of the present SIRPαFc fusion protein.As used herein, “pharmaceutically acceptable carrier” means any and allsolvents, dispersion media, coatings, antibacterial and antifungalagents, isotonic and absorption delaying agents, and the like that arephysiologically compatible and useful in the art of protein/antibodyformulation. Examples of pharmaceutically acceptable carriers includeone or more of water, saline, phosphate buffered saline, dextrose,glycerol, ethanol and the like, as well as combinations thereof. In manycases, it will be preferable to include isotonic agents, for example,sugars, polyalcohols such as mannitol, sorbitol, or sodium chloride inthe composition. Pharmaceutically acceptable carriers may furthercomprise minor amounts of auxiliary substances such as wetting oremulsifying agents, preservatives or buffers, which enhance the shelflife or effectiveness of the pharmacological agent. In embodiments, theSIRPαFc fusion is formulated using practises standard in the art oftherapeutic antibody formulation. Solutions that are suitable forintravenous administration, such as by injection or infusion, areparticularly useful.

Sterile injectable solutions can be prepared by incorporating the activecompound in the required amount in an appropriate solvent with one or acombination of ingredients noted above, as required, followed bysterilization microfiltration. Generally, dispersions are prepared byincorporating the active compound into a sterile vehicle that contains abasic dispersion medium and the required other ingredients from thoseenumerated above. In the case of sterile powders for the preparation arevacuum drying and freeze-drying (lyophilization) that yield a powder ofthe active ingredient plus any additional desired ingredient from apreviously sterile-filtered solution thereof.

As used herein, “effective amount” refers to an amount effective, atdosages and for a particular period of time necessary, to achieve thedesired therapeutic result. A therapeutically effective amount of thepharmacological agent may vary according to factors such as the diseasestate, age, sex, and weight of the individual, and the ability of thepharmacological agent to elicit a desired response in the individual. Atherapeutically effective amount is also one in which any toxic ordetrimental effects of the pharmacological agent are outweighed by thetherapeutically beneficial effects.

The SIRPαFc fusion protein may be administered to the subject throughany of the routes established for protein delivery, in particularintravenous, intradermal and subcutaneous injection or infusion, or byoral or nasal administration. The fusion protein will typically beadministered at a dose in the range 0.5 to 15 mg/kg body weight of thesubject per day. It will be appreciated that the effective dose (anamount effective in treating the disease or condition, as evidenced by areduction in the growth or rate of proliferation or size of the cancercells or mass) will vary according to a number of factors including theage and general health of the subject and the severity of the disease tobe treated.

The amount of active ingredient that can be combined with a carriermaterial to produce a single dosage form will vary depending upon thesubject being treated, and the particular mode of administration. Theamount of active ingredient required to produce a single, unit dosageform will generally be that amount of the composition that produces atherapeutic effect. Generally, out of one hundred percent, this amountwill range from about 0.01 percent to about ninety-nine percent ofactive ingredient, preferably from about 0.1 percent to about 70percent, e.g., from about 1 percent to about 30 percent of activeingredient in combination with a pharmaceutically acceptable carrier.

A composition of the present invention can be administered via one ormore routes of administration using one or more of a variety of methodsknown in the art. As will be appreciated by the skilled artisan, theroute and/or mode of administration will vary depending upon the desiredresults. Preferred routes of administration for fusion proteins of theinvention include intravenous, intramuscular, intradermal,intraperitoneal, subcutaneous, spinal or other parenteral routes foradministration, for example by injection or infusion. The phrase“parenteral administration” that include injection such as intravenous,intramuscular, intraarterial, intrathecal, intracapsular, intraorbital,intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous,subcuticular, intraarticular, subcapsular, subarachnoid, intraspinal,epidural and intrasternal injection and infusion.

Alternatively, a fusion protein of the invention can be administered viaa non-parenteral route, such as a by instillation or by a topical,epidermal or mucosal route of administration, for example, intranasally,orally, vaginally, rectally or sublingually.

Dosing regimens are adjusted to provide the optimum desired response(e.g., a therapeutic response). For example, a single bolus may beadministered, or several divided doses may be administered over time orthe dose may be proportionally reduced or increased as indicated by thetherapeutic situation. It is especially advantageous to formulateparenteral compositions in dosage unit form for ease of administrationand uniformity of dosage. “Unit dosage form” as used herein refers tophysically discrete units suited as unitary dosages for the subjects tobe treated; each unit contains a predetermined quantity of activecompound calculated to produce the desired therapeutic effect inassociation with the required pharmaceutical carrier. The specificationfor the dosage unit forms of the invention are dictated by and directlydependent on (a) the unique characteristics of the active compound andthe particular therapeutic effect to be achieved, and (b) thelimitations inherent in the art of compounding such an active compoundfor the treatment of sensitivity in individuals.

For administration of the fusion protein, the unit dose will be withinthe range from about 0.0001 to 100 mg/kg, and more usually 0.01 to 5mg/kg, of the host body weight. For example dosages can be 0.3 mg/kgbody weight, 1 mg/kb body weight, 3 mg/kg body weight, 5 mg/kg bodyweight or 10 mg/kg body weight or within the range of 1-10 mg/kg. Anexemplary treatment regime entails administration once per week, onceevery two weeks, once every three weeks, once every four weeks, once amonth, once every 3 months or once every three to 6 months. Preferreddosage regimens for the fusion protein of the invention include 1 mg/kgbody weight or 3 mg/kg body weight via intravenous administration, withthe fusion protein being given using one of the following dosingschedules; (i) every four weeks for six dosages, then every threemonths; (ii) every three weeks; (iii) 3 mg/kg body weight once followedby 1 mg/kg body weight every three weeks. In some methods, dosage isadjusted to achieve a plasma fusion protein concentration of about1-1000 ug/ml and in some methods about 25-300 ug/ml.

The present fusion protein displays negligible binding to red bloodcells. There is accordingly no need to account for an RBC “sink” whenestablishing effective dosing regimens. Relative to other SIRPα/CD47inhibitors that are bound by RBCs, it is estimated that the presentSIRP-Fc fusion can be effective at doses that are less than half thedoses required for drugs that become RBC-bound, such as CD47 antibodies.

Moreover, the SIRPα-Fc fusion protein is a dedicated antagonist of theSIRPα-mediated signal, as it displays negligible CD47 agonism whenbinding thereto. There is accordingly no need, when establishingmedically useful unit dosing regimens, to account for any stimulationinduced by the drug.

The fusion protein can also be administered as a sustained releaseformulation, in which case less frequent administration is required.Dosage and frequency vary depending on the half-life of the fusionprotein in the patient. The dosage and frequency of administration canvary depending on whether the treatment is prophylactic or therapeutic.In prophylactic applications, a relatively low dosage is administered atrelatively infrequent intervals over a long period of time. Somepatients continue to receive treatment for the rest of their lives. Intherapeutic applications, a relatively high dosage at relatively shortintervals is sometimes required until progression of the disease isreduced or terminated, and preferably until the patient show partial orcomplete amelioration of symptoms of disease. Thereafter, the patientcan be treated using a prophylactic regimen.

The SIRPαFc proteins of the present invention are useful to treat avariety of CD47+ disease cells. These include particularly CD47+ cancercells, including liquid and solid tumours. In one embodiment, theSIRPαFc proteins are used to inhibit the growth or proliferation ofhematological cancers. As used herein, “hematological cancer” refers toa cancer of the blood, and includes leukemia, lymphoma and myeloma amongothers. “Leukemia” refers to a cancer of the blood, in which too manywhite blood cells that are ineffective in fighting infection are made,thus crowding out the other parts that make up the blood, such asplatelets and red blood cells. It is understood that cases of leukemiaare classified as acute or chronic. Certain forms of leukemia may be, byway of example, acute lymphocytic leukemia (ALL); acute myeloid leukemia(AML); chronic lymphocytic leukemia (CLL); chronic myelogenous leukemia(CIVIL); myeloproliferative disorder/neoplasm (MPDS); andmyelodysplastic syndrome. “Lymphoma” may refer to a Hodgkin's lymphoma,both indolent and aggressive non-Hodgkin's lymphoma, Burkitt's lymphoma,and follicular lymphoma (small cell and large cell), among others.Myeloma may refer to multiple myeloma (MM), giant cell myeloma,heavy-chain myeloma, and light chain or Bence-Jones myeloma.

In some embodiments, the hematological cancer treated with the SIRPαFcprotein is a CD47+ leukemia, preferably selected from acute lymphocyticleukemia, acute myeloid leukemia, chronic lymphocytic leukemia, chronicmyelogenous leukemia, and myelodysplastic syndrome, preferably, humanacute myeloid leukemia.

In other embodiments, the hematological cancer treated with the SIRPαFcprotein is a CD47+ lymphoma or myeloma selected from Hodgkin's lymphoma,both indolent and aggressive non-Hodgkin's lymphoma, Burkitt's lymphoma,follicular lymphoma (small cell and large cell), multiple myeloma (MM),giant cell myeloma, heavy-chain myeloma, and light chain or Bence-Jonesmyeloma as well as leimyosarcoma.

Solid tumours can also be treated with the present fusion protein, toreduce the size, number or growth rate thereof and to control growth ofcancer stem cells. Such solid tumours include CD47+ tumours in bladder,brain, breast, lung, colon, ovaries, prostate, liver and other tissuesas well.

The SIRPαFc protein can be administered alone, as monotherapy, or incombination with any other agent useful in the treatment of the targetedindication.

The SIRPαFc protein also is useful for detecting the presence of CD47+cells. This can be achieved either indirectly, by first incubating theprotein and test cells with the fusion protein and then probing with adetectable agent that binds the fusion protein, or directly by providingthe fusion protein in labeled form.

In another aspect, the present invention features the fusion proteinconjugated to a diagnostic or therapeutic moiety, such as a detectablemarker, a cytotoxin, a drug or a radiotoxin. Conjugates that include oneor more cytotoxins are referred to as “immunotoxins” or drug conjugates.A cytotoxin or cytotoxic agent includes any agent that is detrimental to(e.g., kills) cells. Examples include taxol, ethidium bromide, emetine,mitomycin, etoposide, vincristine, vinblastine, colchicine, doxorubicin,daunorubicin, mitoxantrone, mighramycin, and actinomycin D. Therapeuticagents also include, for example, antimetabolites (e.g., methotrexate,6-mercaptopurine, 6-thioguanine, and cytarabine), alkylating agents(e.g., cyclophosphamide, busulfan, mitomycin C, and cisplatin),anthracyclines (e.g., daunorubicin and doxorubicin), and antibiotics(e.g., dactinomycin (formerly actinomycin), bleomycin, mithramycin, andanthramycin (AMC), and anti-mitotic agents (e.g., vincristine andvinblastine)

Non-limiting examples of detectable markers to which a fusion proteincan be conjugated include fluorescein, cyanin, Cy-3, biotin,radioisotopes including I-¹²³ and I-¹²⁵, and the like. Fusion proteinscan be labelled with such detectable markers by methods known in theart.

Cytotoxins can be conjugated to fusion proteins of the invention usinglinker technology available in the art. Examples of linker types thathave been used to conjugate a cytotoxin to an fusion protein include,but are not limited to, hydrazones, thioethers, esters, disulfides andpeptide-containing linkers.

Fusion proteins of the present invention also can be conjugated to aradioactive isotope to generate cytotoxic radiopharmaceuticals, alsoreferred to as radioconjugates. Examples of radioactive isotopes thatcan be conjugated to fusion proteins for use diagnostically ortherapeutically include, but are not limited to, iodine¹³¹, indium¹¹¹,yttrium⁹⁰, and lutetium¹⁷⁷. Methods for preparing radioconjugates areestablished in the art.

In one embodiment, the fusion proteins can be used to detect levels ofCD47, or levels of cells that contain CD47 on their membrane surface.Detection of CD47 using a SIRPαFc fusion protein can be achieved, forexample, by contacting a sample (such as an in vitro sample) and acontrol sample with the fusion protein under conditions that allow forthe formation of a complex between the fusion protein and CD47. Anycomplexes formed between the fusion protein and CD47 are detected andcompared in the sample and the control. For example standard detectionmethods, well-known in the art, such as ELISA and flow cytometricassays, can be performed using the compositions of the invention.

The fusion proteins thus are useful for diagnostic purposes, includingsample testing and in vivo imaging, and for therapeutic purposes totreat diseases having, as one hallmark, disease cells in which CD47 isupregulated.

For either purpose, the fusion protein can be conjugated to anappropriate agent, to form a drug conjugate. Agents appropriate fortreating disease include cytotoxic agents such as chemotherapeutics andradiotherapeutics. For diagnostic purposes, appropriate agents aredetectable labels that include radioisotopes, for whole body imaging,and radioisotopes, enzymes, fluorescent labels and other suitableantibody tags for sample testing.

For CD47 detection, the detectable labels can be any of the varioustypes used currently in the field of in vitro diagnostics, includingparticulate labels including metal sols such as colloidal gold, isotopessuch as I¹²⁵ or Tc⁹⁹ presented for instance with a peptidic chelatingagent of the N2S2, N3 S or N4 type, chromophores including fluorescentmarkers, luminescent markers, phosphorescent markers and the like, aswell as enzyme labels that convert a given substrate to a detectablemarker, and polynucleotide tags that are revealed followingamplification such as by polymerase chain reaction. Suitable enzymelabels include horseradish peroxidase, alkaline phosphatase and thelike. For instance, the label can be the enzyme alkaline phosphatase,detected by measuring the presence or formation of chemiluminescencefollowing conversion of 1,2 dioxetane substrates such as adamantylmethoxy phosphoryloxy phenyl dioxetane (AMPPD), disodium3-(4-(methoxyspiro{1,2-dioxetane-3,2′-(5′-chloro)tricyclo{3.3.1.13,7}decan}-4-yl) phenyl phosphate (CSPD), as well as CDP and CDP-star®or other luminescent substrates well-known to those in the art, forexample the chelates of suitable lanthanides such as Terbium(III) andEuropium(III). The detection means is determined by the chosen label.Appearance of the label or its reaction products can be achieved usingthe naked eye, in the case where the label is particulate andaccumulates at appropriate levels, or using instruments such as aspectrophotometer, a luminometer, a fluorimeter, and the like, all inaccordance with standard practice.

For SIRPαFc fusion protein-based therapy, the cytotoxin may beconjugated with the fusion protein through non-covalent interaction, butmore desirably, are coupled by covalent linkage either directly or, morepreferably, through a suitable linker. In a preferred embodiment, theconjugate comprises a cytotoxin and a fusion protein. Conjugates of thefusion protein and cytotoxin are made using a variety of bifunctionalprotein coupling agents such as N-succinimidyl-3-(2-pyridyldithiol)propionate, iminothiolane, bifunctional derivatives of imidoesters suchas dimethyl adipimidate HCl, active esters such as disuccinimidylsuberate, aldehydes such as glutaraldehyde, bis-azido compounds such asbis-(p-diazoniumbenzoyl)-ethylenediamine), diisocyanates such as toluene2,6-diisocyanate, and bis-active fluorine compounds (such as1,5-difluoro-2,4-dinitrobenzene). C¹⁴-labeled1-isothiocyanobenzyl-3-methyldiethylene triaminepentaacetic acid(MX-DTPA) is a chelating agent suitable for conjugation of radionuclideto the antibody.

The cytotoxin component of the immunoconjugate can be a chemotherapeuticagent, a therapeutic antibody, a toxin such as an enzymatically activetoxin of bacterial, fungal, plant or animal origin, or fragmentsthereof, or a small molecule toxin, or a radioactive isotope such as²¹²Bi, ¹³¹I, ¹³¹In, ¹¹¹In, ⁹⁰Y and ¹⁸⁶Re, or any other agent that actsto inhibit the growth or proliferation of a cancer cell.

Chemotherapeutic agents useful in the generation of such drug conjugatesinclude the maytansinoids including DM-1 and DM-4, auristatins,adriamycin, doxorubicin, epirubicin, 5-fluorouracil, cytosinearabinoside (“Ara-C”), cyclophosphamide, thiotepa, busulfan, cytoxin,taxoids, e.g. paclitaxel, and docetaxel, taxotere, methotrexate,cisplatin, melphalan, vinblastine, bleomycin, etoposide, ifosamide,mitomycin C, mitoxantrone, vincristine, vinorelbine, carboplatin,teniposide, daunomycin, carminomycin, aminopterin, dactinomycin,mitomycins, esperamicins, 5-FU, 6-thioguanine, 6-mercaptopurine,actinomycin D, VP-16, chlorambucil, melphalan, and other relatednitrogen mustards. Also included are hormonal agents that act toregulate or inhibit hormone action on tumors such as tamoxifen andonapristone. Toxins and fragments thereof which can be used includediphtheria A chain, nonbonding active fragments of diphtheria toxin,cholera toxin, botulinus toxin, exotoxin A chain (from Pseudomonasaeruginosa), ricin A chain, abrin A chain, modeccin A chain,alpha-sarcin, Aleurites fordii proteins, dianthin proteins, phytolacaAmericana proteins (PAPI, PAPII, and PAP-S), Momordica charantiainhibitor, curcin, crotin, sapaonaria, officinalis inhibitor, gelonin,saporin, mitogellin, restrictocin, phenomycin, enomycin, and thetricothcenes. Small molecule toxins include, for example,calicheamicins, maytansinoids, palytoxin and CC1065.

Fusion proteins bind selectively to the target antigen, CD47, and areused, in accordance with an aspect of the invention, to screen cancerand other disease cells to detect those which present the CD47 antigenat high density. In a preferred embodiment, screening is applied to asample of cancer cells taken from a subject that is a candidate forSIRPαFc fusion protein therapy. Subjects testing positive for cancercells that present the CD47 antigen at high density can then bescheduled for therapy with the present fusion protein, or a conjugatehybrid thereof. Standard techniques, combined with the fusion proteinsherein described can be used to screen cancer cells. Desirably, thefusion protein incorporates a detectable label. The label may bedetectable by itself. (e.g., radio-isotope labels or fluorescent labels)or, in the case of an enzymatic label, may catalyze chemical alterationof a substrate compound or composition which is detectable.Radionuclides that can serve as detectable labels include, for example,I-¹³¹, I-¹²³, I-¹²⁵, Y-⁹⁰, Re-¹⁸⁸, Re-¹⁸⁶, At-²¹¹, Cu-⁶⁷, Bi-²¹², andPd-¹⁰⁹.

In situ detection of the binding to CD47+ cancer cells can be performed,using the present antibody or fragment, by immunofluorescence orimmunoelectron microscopy. For this purpose, a histological specimen isremoved from the patient, and a labeled form of the fusion protein isapplied to it, preferably by overlaying the antibody on a biologicalsample. This procedure also allows for distribution of the CD47 antigento be examined within biopsied tumour tissue. It will be apparent forthose skilled in the art that a wide variety of histological methods arereadily available for in situ detection.

More particularly, SIRPαFc fusion proteins of the present invention maybe used to monitor the presence or absence of fusion protein reactivityin a biological sample (e.g., a tissue biopsy, a cell, or fluid) usingstandard detection assays. Immunological assays may involve directdetection, and are particularly suited for screening large amounts ofsamples for the presence of cancer cells that are CD47+. For example,the fusion protein can be used in the role of any antibody in anystandard immunoassay format (e.g., ELISA, Western blot,immunoprecipitation, flow cytometry or RIA assay) to measure complexformation. Any appropriate label which may be directly or indirectlyvisualized may be utilized in these detection assays including, withoutlimitation, any radioactive, fluorescent, chromogenic (e.g., alkalinephosphatase or horseradish peroxidase), or chemiluminescent label, orhapten (for example, digoxigenin or biotin) which may be visualizedusing a labeled, hapten-specific antibody or other binding partner(e.g., avidin). Exemplary immunoassays are described, e.g., in Ausubelet al., supra, Harlow and Lane, Antibodies: A Laboratory Approach, ColdSpring Harbor Laboratory, New York (1988), and Moynagh and Schimmel,Nature 400:105, 1999. For example, using the fusion proteins describedherein, high density CD47 is readily detected at the cell surface usingstandard flow cytometry methods. Samples found to contain labeledcomplex compared to appropriate control samples are taken as indicatingthe presence of high density CD47, and are thus indicative of a canceror other disease amenable to treatment with the present fusion proteins.

It will be appreciated that the present fusion proteins comprise twomolecules, each comprising a single chain polypeptide that incorporatesa SIRPα protein component fused to an Fc component. Fusion of the singlechain polypeptides to form a dimer results from disulfide bridges thatform between the Fc components when the single chain polypeptides aresecreted from the host cell producing them. Thus, the product recoveredas a fusion protein is a dimeric protein resulting from the disulfidelinkage between two molecules of the single chain polypeptideincorporating both the Fc component and the SIRPα component.

The present invention thus provides not only the single chainpolypeptides in which the SIRPα protein component is fused with the Fcregion, i.e., the CH component, but also provides a dimeric fusionprotein in which two copies of these single chain polypeptides are fusedvia their respective Fc components. Multimeric forms, in which more thantwo copies of each polypeptide are fused, are also within the scope ofthe invention.

To produce the present SIRPαFc fusion proteins, DNA encoding asecretable form of the single chain polypeptide is obtained,incorporated within a suitable expression/secretion vector, and thentransfected into a suitable production host. Culturing of the resultingtransfectant yields the dimeric fusion protein as a secreted productwhich can then be harvested and purified, all in general accordance withestablished practise, and as exemplified herein. A polypeptide in singlechain form can be obtained similarly, but is produced without the aid ofa secretion signal and in a host such as a prokaryote so thatdimerization does not occur and the polypeptide is recoverable as anintracellular protein.

Accordingly, the present invention also provides polynucleotides,including DNA and RNA, which upon expression yield a secretable form ofthe single chain polypeptides that make up the present fusion proteins.A polynucleotide encoding a preferred and secretable single chainpolypeptide comprises the DNA sequence having SEQ ID No.8, in which thefirst 90 residues encode the 30-mer secretion signal native to humanSIRPα, and the remaining nucleic acid residues (SEQ ID No. 7) encode thesingle chain FSIRPαFc polypeptide. Embodiments include polynucleotidesin which one or more codons are substituted by codons synonymous withthose illustrated.

In related embodiments, there is provided a polynucleotide that encodesa secretable form of the IgG1-based fusion protein having SEQ ID No. 25,the polynucleotide comprising SEQ ID No.27. Also provided is apolynucleotide that encodes a secretable form of the IgG4-based fusionprotein having SEQ ID No. 26, the polynucleotide comprising SEQ IDNo.28.

It will be appreciated that the polynucleotides can be synthesized denovo, using standard gene synthesis and cloning and amplificationtechniques to assemble the intact polynucleotides. Alternatively, andfor example, a polynucleotide encoding the SIRPα protein component(e.g., SEQ ID No. 5) and a polynucleotide encoding the selected Fccomponent (e.g., SEQ ID No. 6) can be obtained by PCR amplification frompublicly available sources of these genes, and the amplifiedpolynucleotides can be linked by ligation, either directly or through alinker that encodes one or more amino acid residues innocuous in termsof biological activity, all in accordance with established techniques,and as exemplified herein.

For expression, a polynucleotide encoding the single chain polypeptidein secretable form is incorporated within vectors such as plasmidssuitable for expressing the polynucleotides in the chosen fusion proteinproduction host. Such vectors are available commercially, and typicallyare constructed to permit introduction of the polynucleotide encodingthe secretable fusion protein directly under the control of a promotereffective to drive expression in the chosen host. Host transfectionprocedures are well established in the art, and expression systems thatinclude vectors, and expression hosts for such vectors, are availablecommercially. These include the pcDNA vectors suitable forcotransfection into hosts 293, CHO or NSO, to express the fusionprotein-encoding polynucleotides under control of the CMV promoter,available from Invitrogen, and the pTandem-1 vector system forexpressing fusion protein chains under the CMV promoter and frombicistronic RNA in 293, CHO or NSO hosts, also available fromInvitrogen. Another useful expression system, described in the examplesherein, makes use of the CMV promoter and is available commercially fromthe Biotechnology Research Institute in Montreal, Canada.

Suitable production hosts for the fusion proteins of the invention arecells that incorporate, either transiently or stably, a polynucleotideencoding the fusion-forming single chain polypeptide in secretable form.The expressed form of the fusion protein incorporates a signal sequenceenabling the secretion of each fusion protein chain from the host,thereby to permit the formation of desired disulfide linkages within andacross the produced fusion protein chains, and provide a functionalfusion protein. The secretion signal can be encoded by any such signalfunctional in the chosen host. In one embodiment, the secretion signalis the secretion signal normally associated with the SIRPα proteincomponent.

Suitable mammalian host cells for expressing the recombinant fusionproteins of the invention include Chinese Hamster Ovary (CHO cells,including dhfr-CHO cells and CHOcTA cells), NSO myeloma cells, SOS cellsand SP2 cells. In a specific embodiment, the host is a CHO cell line,such as a CHO-S cell line. For use with NSO myeloma cells, anotherpreferred expression system is the GS gene expression system disclosedin WO 87/04462, WO 89/01036 and EP 338,841. The fusion proteins areproduced by culturing the transfected host cells for a period of timesufficient to allow for secretion of the fusion protein into the culturemedium in which the host cells are grown. Fusion proteins can recoveredfrom the culture medium using standard protein purification methods, allas now exemplified.

Examples

In the description of the work that follows, reference is made to fusionproteins by code. For convenience, the functional components of thereferenced fusions are summarized below:

TABLE 1 Fc Effector Protein SIRPα Region Fc Region Activity TTI-601hSIRPα V1, 3 domains (340 aa) hIgG4 (mut) None TTI-602 hSIRPα V2, 3domains (339 aa) hIgG4 (mut) None TTI-616 hSIRPα V2, 1 domain (118 aa)hIgG4 (mut) None TTI-620 hSIRPα V2, 1 domain (114 aa) hIgG4 (WT)* LowTTI-621 hSIRPα V2, 1 domain (118 aa) hIgG1 (WT) High TTI-622 hSIRPα V2,1 domain (118 aa) hIgG4 (WT) Low TTI-623 hSIRPα V2, 1 domain (118 aa)hIgG4 (mut) None FD6 mutations{circumflex over ( )} TTI-624 hSIRPα V2, 1domain (118 aa) hIgG4 (mut) None CV1 mutations{circumflex over ( )}R&D** hSIRPα V1, 3 domains (339 aa) hIgG1 (WT) High All human IgG4 Fcregions possess the hinge-stabilizing S²²⁸P mutation, except whereindicated with an asterisk*. IgG4 Fcs designated as “mut” containmutations at positions 233-236 (EU numbering system) that further reduceFcγR binding (Armour et al. 1999 Eur. J. Immunol. 29: 2613). {circumflexover ( )}FD6 mutations (L4V, V6I, A27I, I31F, E47V, K53R, E54Q, H56P,V63I, L66T, K68R, V92I) and CV1 mutations (V6I, A27I, I31F, E47V, K53R,E54Q, H56P, L66T, V92I) described in Weiskopf et al. 2013 Science 341:88. **Commercially available protein sold by R&D Systems (Cat#4546-SA-050).

1. SIRPα-Fc Fusion Protein Production

The SIRPαFc constructs were generated by a three-stage cloning process,using the primers shown below:

P#5863: SEQ ID No. 9 GGCGCTAGCCACCATGGAGC P#5929: SEQ ID No. 10GGTGAAGCTCACTGTGTGCTG P#5930: SEQ ID No. 11 CAGCACACAGTGAGCTTCACCP#1035: SEQ ID No. 12 CCGGATCCTCATTTACCCAG P#0874: SEQ ID No. 13GGACTCAGAGGGTTTGGCACGCACAGA P#0875: SEQ ID No. 14CCCTCTGAGTCCAAATATGGTCCCCCA P#4197: SEQ ID No. 15AGTTTTGTCAGAGGGTTTGGCACGCACAGA P#4198: SEQ ID No. 16AAACCCTCTGACAAAACTCACACATGCCCA P#1737: SEQ ID No. 17CACGGATCCTCATTTACCCGG P#4195: SEQ ID No. 18 AGGTGCTGGGCATGGTGGGCATGGGGGP#4196: SEQ ID No. 19 CCCCCATGCCCACCATGCCCAGCACCT P#2058: SEQ ID No. 20CACGGATCCTCATTTACCCAGAGACAGGG

In the first PCR reaction, 100 ng of template DNA (synthetic human SIRPαGenBank #AAH26692, from Blue Heron Biotechnology) was amplified usingplatinum Pfx DNA polymerase (Invitrogen) in 1 mM MgSO₄, 0.4 mM each dNTPand 20 pmol of each primer, according to the conditions below:

TTI-602: primers P #5863 and P #5929; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 1 min, 56° C. for 2min, and 68° C. for 2 min.

TTI-616: primers P #5863 and P #0874; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 1 min, 50° C. for1.5 min, and 63° C. for 3 min.

TTI-621: primers P #5863 and P #4197; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 0.5 min, 50° C. for1.5 min, and 63° C. for 3 min.

TTI-622: primers P #5863 and P #4195; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 0.5 min, 50° C. for1.5 min, and 63° C. for 3 min.

The reactions were then held at 72° C. for 10 min and cooled to 4° C.The reaction products were electrophoresed through 1-1.4% agarose gelsand visualized with ethidium bromide.

Next, the IgG Fc fragments were amplified in reaction PCR2, using PfxDNA polymerase (Invitrogen), in 1 mM MgSO₄, 0.4 mM each dNTP, 20 pmol ofeach primer and 100 ng of template DNA (human IgG1 and human IgG4,previously cloned) under the following conditions:

TTI-602: primers P #5930 and P #1035; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 1 min, 56° C. for 2min, and 72° C. for 2 min.

TTI-616: primers P #0875 and P #1035; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 1 min, 50° C. for1.5 min, and 63° C. for 3 min.

TTI-621: primers P #4198 and P #1737; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 0.5 min, 60° C. for0.5 min, and 68° C. for 0.5 min.

TTI-622: primers P #4196 and P #2058; initial melting at 94° C. for 5min, followed by 30 cycles consisting of 94° C. for 0.5 min, 50° C. for1.5 min, and 63° C. for 3 min.

The reactions were then held at 72° C. for 10 min and cooled to 4° C.The reaction products were electrophoresed through 1-1.4% agarose gelsand visualized with ethidium bromide.

Finally, the SIRPα and Fc cDNA was assembled by overlapping PCR inreaction PCR3. Products from PCR1 and PCR2 (100 ng) were incubated withplatinum Pfx DNA polymerase (Invitrogen), in 1 mM MgSO₄, and 0.4-0.8 mMeach dNTP at 94° C. for 5 min, followed by 10 cycles consisting of 94°C. for 30 sec-1 min, then 52-60° C. for 80 sec-3 min, and cooled to 4°C. Primers (20-40 pmol each) were then added to first reaction and asecond-stage reaction run under the following conditions: melting at 94°C. for 5 min, followed by 30 cycles consisting of 94° C. for 30 sec-1min, 50-56° C. for 30 sec-3 min and 30 sec. The details of eachcondition are below:

TTI-602: 10 cycles at 94° C. for 1 min and 56° C. for 3 min, followed by30 cycles of 94° C. for 1 min, 55° C. for 2.5 min, and 72° C. for 3 minusing primers P #5863 and P #1035.

TTI-616: No first PCR cycle; 30 cycles of 94° C. for 1 min, 50° C. for 2min, and 63° C. for 3.5 min using primers P #5863 and P #1035.

TTI-621: 10 cycles at 94° C. for 1 min and 52° C. for 3 min, followed by30 cycles of 94° C. for 1 min, 52° C. for 2 min, and 63° C. for 4 minusing primers P #5863 and P #1737.

TTI-622: 10 cycles at 94° C. for 1 min and 60° C. for 3 min, followed by30 cycles of 94° C. for 1 min, 52° C. for 2 min, and 63° C. for 4 minusing primers P #5863 and P #2058.

The reactions were then held at 68-72° C. for 7-8 min and cooled to 4°C. The reaction products were separated through 1-1.4% agarose gels andvisualized with ethidium bromide and ligated into the pMPG expressionvector (Biotechnology Research Institute in Montreal, Canada) asfollows: The DNA band of interest from PCR amplification was excised andpurified from agarose gel by using QIAquick Gel Extraction Kit (Qiagen).This purified PCR product was digested with NheI and BamHI restrictionenzymes (New England BioLabs) and purified from gel using the Qiaquickgel Purification Kit (Qiagen). The fragment was then ligated by T4 DNAligase (Invitrogen) into the pMPG expression plasmid that had beensimilarly digested with NheI and BamHI enzymes. The pMPG plasmid uses aCMV promoter and TK Poly A terminator and contains hygromycin resistanceselection marker. 2 μl of the ligation reaction was then transformedinto 25 μl of competent E. coli DH5a cells (Invitrogen) according themanufacturer instructions. Transformants were spread on LB-agar platescontaining 100 μg/ml ampicillin (Sigma), followed by incubation at 37°C. for 20 hours. Plasmid DNA was extracted and purified from small-scaleE. coli cultures by using the QIAprep Spin mini-prep Kit (Qiagen), andthe DNA sequence was confirmed by automated sequencing using fluorescentdye-conjugated ddNTPs (Core Molecular Biology Facility, YorkUniversity). For transfections, large quantities of plasmid DNA wereprepared using the EndoFree Plasmid Maxi kit (Qiagen), then the sequencereconfirmed by automated sequencing using fluorescent dye-conjugatedddNTPs (Core Molecular Biology Facility, York University).

Cell Line Production

Stable transfectants were generated using CHO-S cell line (Invitrogen).Briefly, plasmid DNA isolated was linearized by Xbal (New EnglandBioLabs), and purified using QIAGEN columns (Qiagen). CHO-S cellsgrowing in serum-free chemical defined medium (CD-CHO, Invitrogen)supplemented with 8 mM L-glutamine and 1×HT-supplement were transfectedwith the linearized plasmid using Lipofectamine 2000 reagent(Invitrogen). After 48 hours, the cells were transferred into 96-wellplates and plated out at different concentrations (10000, 5000, or 2000cells/well) in medium containing 600 μg/mL of hygromycin B (Invitrogen).Mock transfection control was carried out in identical fashion with noDNA added to the mix. 2-3 weeks following transfection a panel ofdrug-resistant oligoclones was picked up and the supernatants from a 48hr expression study were screened by ELISA as follows: 96-well plateswere coated with 0.1 μg/well of capture Ab (goat anti-human IgGFc), andincubated overnight at 4° C. The wells were washed and blocked with 200μl of 2% BSA in PBST at room temperature for 1 hour. After washing, 100μl samples were diluted with 1% BSA in PBST, added to the wells,incubated for 1 hour, washed and then incubated with HRP-conjugateddetection Ab (HRP-conjugated goat anti-human IgGFc), for 1 hour at roomtemperature. The wells were then washed and TMB substrate (Moss Inc.)added and incubated for 3 to 5 min at room temperature. Absorbance wasmeasured at 450 nm/655 nm wavelength using iMark microplate reader(Biorad), and a standard curve was constructed using known amount ofpurified fusion protein. A second limiting dilution of the 3 highestexpressing oligo-clones was performed at lower cell concentrations (0.1,0.25, and 0.5 cells/well) in complete CD-CHO medium containing 600 μg/mlof hygromycin B. After 2 to 3 weeks, the drug-resistant clones wereagain assessed for recombinant protein production by ELISA as describedabove. The productivity was expressed in pg/cell/day and was in therange of 1.4-23.9 pg/cell/day for the human SIRPα fusion proteins. Thehighest expressing single cell clones were used for supernatant batchproduction in a WAVE Bioreactor system. In some instances before thesingle clone stage was reached, the best oligo clone was used forproduction.

Protein Purification

For rapid production of small lots of proteins, some SIRPα-Fc batcheswere made in transiently transfected 293F cells. Briefly, FreeStyle 293Fcells (Invitrogen) were grown in 293F medium (Invitrogen), transfectedwith non-linearized plasmid DNA and 293Fectin reagent (Invitrogen) andgrown in shaker flask batches in volumes 80-100 mL/flask at 37° C., 5%CO2 for 3-6 days. Cell density and viability were monitored every dayuntil cell viability dropped to −90%. Cell viability at batch harvestwas in the range 85-90%.

For purification from CHO-S cells, 5 or 10 L culture supernatant wasgenerated from stably transfected high expressing oligo or single cellclones in a WAVE disposable bag bioreactor system Base20/50 EHT (GEHealthcare). Briefly, CHO-S transfectants were grown in static T150flasks in completed growth medium (CD-CHO supplemented with 8 mML-glutamine, 1×HT-supplement, and 600 μg/mL of hygromycin B) at 37° C.to produce sufficient cell numbers to initiate a 1 L or a 2 L culture at0.5×10⁶ cells/mL for a 5 L or a 10 L run respectively. The bioreactorbag was inoculated and the cells were then incubated at 37° C., 10% CO2,rocking speed 15-20 rpm, angle 7°, and air flow 0.2-0.4 Lpm. When theculture reached a density of 2 to 2.5×10⁶ cells/mL (usually within 2-3days of inoculation), the bioreactor was further scaled up to 5 L or 10L and incubated further at 37° C., 10% CO2, rocking speed 15-20, angle7°, air flow 0.2-0.4 Lpm. When the cells have reached a density of1-1.5×10⁶ cells/mL the temperature was dropped to 30° C. and culture wasfurther incubated for additional 7 to 10 days at the conditionsspecified above. Starting on day 0 at 30° C. the cultures were fed with1% CHO feed bioreactor supplement (Sigma) every two days and wereharvested when the cell viability dropped around 90%. The supernatantwas collected, centrifuged at 3000×g for 40 min at 4° C. and frozen at−20° C. until purification.

All proteins were purified by a two-step procedure, first using proteinA chromatography. Buffer exchanged supernatant was diluted 9-fold withbinding buffer (20 mM Na—P & 3 M NaCl, pH 7.8) and loaded onto arProtein A column (GE Healthcare) at a flow rate of 2-3 mL/min(depending on loading volume and loading time) overnight at 4° C. Thecolumn was then washed with binding buffer (20 volumes at 3 mL/min), andprotein eluted with 0.1 M citric acid pH 4.0 and pH 2.2 at 3 mL/min.Eluted material was pH adjusted to neutral with 1M and subsequentlypurified using HiTrap Phenyl HP chromatograph. Briefly, proteins werediluted at least 4-fold to 0.2 M ammonium sulphate pH 7.5 and loadedonto the HiTrap Phenyl HP column (GE Healthcare) at 2-3 mL/min(depending on column size and loading time). Non-aggregated SIRPαFcprotein was collected in the flow-through fraction. Tangential flowfiltration using a BioMax 10 membrane (Millipore) was used toconcentrate and buffer exchange the protein into PBS pH 7.4. The qualityof each protein was determined by SD S-PAGE, Western blot using goatanti-IgGFc antibody and rabbit anti-goat IgG HRP conjugate, and HPLCanalysis. The identity of all proteins was confirmed by N-terminalsequencing and mass spectrometry.

1. Comparison of One and Three Domain SIRPαFc Fusions

SIRPα consists of three extracellular immunoglobulin (Ig)-like domains,however binding to CD47 is localized to the N-terminal domain. Todetermine the optimal SIRPα region for SIRPαFc fusions, we generatedproteins incorporating either all three extracellular SIRPα domains(TTI-602) or the single N-terminal domain (TTI-616).

Both proteins were constructed on a mutated human IgG4 Fc backbone thatlacks effector function. We compared the binding of TTI-602 and TTI-616to human CD47 using a direct binding assay (FIG. 1A) and an indirectcompetition assay (FIG. 1B). For the direct binding assay, CD47+ humanJurkat cells were incubated with the various concentrations (asindicated) of hSIRPαFc proteins on ice for 1 hour. The cells were thenwashed to remove any unbound protein and then incubated with ananti-hIgG Fcg specific (Fab′)₂ FITC antibody on ice for 1 hour. Thecells were then washed and fixed by incubating with a 2%paraformaldehyde solution overnight. The fixing solution was then washedoff and the cells were analyzed by flow cytometry (BD FACScan). Data wasfit to a one site binding model using nonlinear regression. For theindirect assay, a fixed, saturating amount of biotinylated human SIRPαFc(TTI-601) was incubated either alone or with titrated amounts of TTI-602or TTI-616 for 15 min on ice. This mixture was then added to human CD47+Jurkat cells, incubated on ice for 1 hour, washed to remove unboundprotein, and then incubated with a saturating amount of streptavidin-PEon ice in the dark for 1 hr. The cells were then washed, fixed andanalyzed by flow cytometry as above. The geometric means were thennormalized, with 100% inhibition being the geometric mean of theStreptavidin-PE alone and 0% inhibition being the geometric mean of theBiotinylated TTI601 alone. A line of best fit was obtained by nonlinearregression analysis using the sigmoidal dose-response curve fit (Prism,Graphpad).

The data in FIGS. 1A and 1B clearly show a binding difference betweenTTI-602 and TTI-616, with TTI-616 binding with higher affinity in bothassays. In the direct binding assay, TTI-616 bound with 10-fold higheraffinity than TTI-602 (EC50 values: 13.4 nM versus 139 nM). In theindirect binding assay, TTI-616 bound with 7-fold higher affinity thanTTI-602 (EC₅₀ values: 4.5 nM versus 32.1 nM). These results wereunexpected, as previously published data indicate that the N-terminaldomain of SIRPα bound to CD47 with comparable affinity to SIRPαcontaining all three extracellular domains (Hatherley et al. 2007 J.Biol. Chem. 282:14567).

2. Design of Human SIRPαFc Fusions with Different Fc Regions

Having established a preference for a fusion protein incorporating asingle SIRPα domain, studies were conducted to determine the optimal Fcregion. Three different human SIRPαFc fusions were generated thatcontain the same SIRPα region (31-148) but were constructed on differentFc components which have varying effector activity. The design detailsare summarized in Table 2 below. The annotated DNA and protein sequencesare shown in Appendix 1.

TABLE 2 Design of human SIRPαFc fusion proteins. SIRPα Effector ProteinRegion Fc Isotype Activity TTI-621 V2 IgV domain Human IgG1 (lowerhinge-CH2-CH3 High domains) TTI-622 V2 IgV domain Human IgG4(hinge-CH2-CH3 Low domains) with Ser-Pro mutation at position 158*TTI-616 V2 IgV domain Human IgG4 (hinge-CH2-CH3 None domains) withmutations: Ser158Pro*; Glu163Pro; Phe164 Val; Leu165Ala; and deletion ofGly166** *Corresponds to position 228 in EU numbering system, and isintended to stabilize the IgG4 hinge region and prevent formation ofintrachain disulfides leading to monomer formation (Angal et al. 1993Mol. Immunol. 30: 105) **Corresponds to positions 233-236 in EUnumbering system, and is intended to further reduce Fcγ receptor binding(Armour et al. 1999 Eur. J. Immunol. 29: 2613).

3. Binding of SIRPαFc Fusions to CD47

The three SIRPαFc fusions were compared for binding to cell surfacehuman CD47. Briefly, CD47+ human Jurkat cells were incubated with thevarious concentrations (as indicated) of hSIRPαFc proteins on ice for 1hour. The cells were then washed to remove any unbound protein and thenincubated with an anti-hIgG Fcg specific (Fab′)₂ FITC antibody on icefor 1 hour. The cells were then washed and fixed by incubating with a 2%paraformaldehyde solution overnight. The fixing solution was then washedoff and the cells were analyzed by flow cytometry (BD FACScan). Thegeometric means were then normalized and the binding curves and Kdvalues were generated by Prism (Graphpad) using nonlinear regressionfitting the data to a one site binding model.

As shown in FIG. 2, the three fusion proteins showed very similarbinding profiles, producing nearly identical affinity binding (Kd)values (2.3-2.4 nM). This was expected, as all three proteins containthe same SIRPα region and the Fc region was not predicted to affectligand binding.

4. In Vitro Pro-Phagocytosis Activity of SIRPαFc Fusions

Blockade of CD47 by SIRPαFc enhances the phagocytosis of human acutemyeloid leukemia (AML) tumor cells by activated human macrophages. Thepro-phagocytic activity of the three fusion proteins was compared invitro to determine if the Fc region affects AML phagocytosis. Humanmacrophages were generated by first isolating CD14+ monocytes fromFicoll-purified human peripheral blood mononuclear cells using magneticselection. Monocytes were cultured in X-vivo media containing humanmonocyte colony stimulating factor at 20 ng/ml for at least 1 week topromote development into macrophages. The macrophages were then platedonto glass slides in a 24-well culture plate and incubated with humaninterferon gamma overnight. The next day, the wells were washed and LPSwas added for at least 1 hour. Human AML cells were counted and labelledwith CFSE. After labelling, the AML cells were incubated for 15 min atroom temperature (RT) with PBS, SIRPαFc proteins or isotype controls.The AML cells were then added to the individual wells, mixed andincubated in a 37° C., 5% CO2 humidified cell incubator for 2 hours.After the incubation, the wells were washed and the macrophages werelabelled with the wheat germ agglutinin Alexa Fluor® 555 conjugate(Invitrogen, cat #W32464) for 15 min at RT with rocking. The wells werethen washed and fixed with 2% paraformaldehyde for 30 min at RT. Thewells were then washed and kept in dark at 4° C. overnight. The glassslides were analyzed by scanning confocal microscopy (Quorum Wave FX-X1Spinning Disc Confocal System, Quorum Technologies, Guelph, ON, Canada).The phagocytosis of AML cells was quantified using a phagocytosis index,as follows: (number of AML cells inside macrophages/number ofmacrophages)×100; counting at least 200 macrophages per sample. As shownin FIG. 3, TTI-621 and TTI-622 exhibit similar pro-phagocytosisactivity, whereas TTI-616 is clearly weaker (this is particularlyevident at the 10 nM dose). This indicates either a wild type IgG4 orIgG1 Fc region is required for maximal SIRPαFc-triggered tumor cellkilling by macrophages.

An expanded panel of SIRPαFc fusion proteins was evaluated forphagocytosis activity using the AML cell line OCI/AML-2 as targets. Asshown in FIG. 6, the data clearly indicate that the highest level ofAML-2 phagocytosis is induced by fusion proteins containing a singleSIRPα domain and a wild type IgG4 or IgG1 Fc region (i.e., TTI-622, -620or TTI-621). Fusion proteins lacking any Fc effector function (e.g.,TTI-616) can trigger phagocytosis, but the effect is considerablyweaker. This is consistent with the data reported in FIG. 3. SIRPαFcwith three extracellular domains (TTI-601, TTI-602 and R&D) also exhibitonly a low level of pro-phagocytic activity, and in the case of the R&Dfusion this poor activity cannot be overcome with an IgG1 Fc region. Inaddition, fusion proteins containing mutated SIRPα sequences that confersubstantially higher CD47 binding (TTI-623 and TTI-624) do not result inhigher phagocytosis activity compared to a wild type SIRPαFc bearing thesame Fc region (TTI-616). These results suggest that increasing the CD47binding affinity beyond the level achieved with a wild type single SIRPαdomain does not result in any further benefit in vitro. This conclusionis unexpected, as it was reported that FD6 and CV1 mutated SIRPα linkedto IgG4 Fc have greater pro-phagocytic activity than wild typeSIRPα-IgG4 (Weiskopf et al. 2013 Science 341:88).

5. In Vivo Anti-Leukemic Activity of SIRPαFc Fusions

The three SIRPαFc fusion proteins were tested for their ability tocontrol the growth of human AML tumor cells in a standardxenotransplantation model. NOD/ShiLtJ-Prkdcscid (NOD. SCID) mice (8-12weeks old) were sublethally irradiated with 275 cGy from a 137Csγ-irradiator 24 hours before intrafemoral injection of AML cellscollected from a human leukemia patient. Starting three weeks aftertransplantation, mice were treated with SIRPαFc fusion proteins (8 mg/kgIP three times per week) or equimolar doses of control Fc proteinsTTI-401 (mutated human IgG4) or TTI-402 (human IgG1). After 4 weeks oftreatment, mice were sacrificed and human leukemia cells in the injectedfemur, non-injected bone marrow and spleen detected by flow cytometricanalysis, staining for expression of human CD45 and human CD33 markers.The AML engraftment was expressed as the percentage of human CD45+CD33+cells in each compartment.

As shown in FIG. 4, the TTI-621 fusion protein bearing an IgG1 Fc regionwas the only protein capable of mediating an anti-leukemic effect at thesite of transplantation (the injected femur). In the non-injected bonemarrow, there was a clear Fc dependent effect, with TTI-621 (full Fcactivity)>TTI-622 (low Fc activity)>TTI-616 (no Fc activity). All threefusion proteins exhibited anti-leukemic activity in the spleen, althoughthis site is a less rigorous test of activity, as the overallengraftment level (as seen in control mice) is much lower than in theinjected or non-injected bone marrow. Collectively, these resultsindicate that a SIRPαFc protein bearing a human IgG1 Fc region has thegreatest activity in a human AML xenotransplantation model. The superiorin vivo activity of the IgG1-based fusion would not have been predictedbased on the in vitro phagocytosis data (FIG. 2), in which TTI-621 andTTI-622 showed similar activity.

6. Hemagglutination Activity of SIRPαFc Fusions

Human red blood cells were prepared using heparinized whole blood fromhealthy donors. 4 mL whole blood was pipetted in a 15 mL conical tube,topped up with phosphate buffered saline (PBS) and centrifuged at 200×g,room temperature for 10 minutes to remove the platelets. Afteraspiration of the platelet fraction the tube was topped up to 15 mL withPBS, the content mixed well by inverting the tube and the RBCs werepacked by centrifugation at 1500 rpm for 5 minutes. This wash wasrepeated 3 more times. After the final wash the supernatant wasaspirated and enough PBS was added to the packed erythrocytes to make a10% RBC solution (for example, if 1 mL packed RBCs were obtained theywere further diluted with 9 mL PBS to make a 10% RBC solution). 10% RBCsolution stored at 4 C was usable within a week. A fresh 1% RBC solutionwas made immediately prior to the hemagglutination assay.

SIRPαFc proteins expressed in either CHO or 293 cells were analyzed fortheir ability to agglutinate human RBCs as evidenced by RBC aggregationand prevention of RBC pellet formation. The assay was performed in96-well non-tissue culture treated, low protein binding round bottomplates. A fresh 1% RBC solution was made immediately prior to thehemagglutination assay. 50 μL of 1% RBC solution was transferred to eachwell. 3-fold serially diluted human SIRPα-Fc fusion proteins starting at3 μM final concentration or vehicle control were added at 50 μL per wellto the appropriate wells. Wells were mixed gently and incubatedovernight at 37° C., 5% CO2. After an overnight incubation the plateswere photographed. In the absence of crosslinking, the erythrocytes rollto the bottom of the wells and appear as a tight pellet. Evidence ofhemagglutination is demonstrated by the presence of non-settled RBCsappearing as a haze compared to a well-defined RBC pellet. SIRPα fusionproteins that trigger hemagglutination will prevent the formation of anRBC pellet and thus produce a diffuse or hazy pattern. Results indicatethat the three-domain SIRPαFc fusion proteins TTI-601 and TTI-602 showan increased propensity to induce hemagglutination compared tosingle-domain fusions. This suggests that single-domain SIRPαFcs wouldbe less likely to cause RBC toxicity in vivo.

7. CD47 Agonist Activity of SIRPαFc Fusions

Human Jurkat T cells Clone E6-1 were purchased from ATCC (Cat #TIB-152)and grown in RPMI 1640 supplemented with 10% FBS, 2 mM L-glutamine, 1 mMsodium pyruvate, 10 mM HEPES, and 1.5 g/L sodium bicarbonate. CD47expression was analysed by flow cytometry by demonstrating cell surfacebinding of anti-CD47 mAbs clones B6H12, 2D3, BRIC126, and CC2C6. The dayprior to an agonist assay Jurkat cells were seeded at 3×10⁵ cells/mL ina complete growth media in T75/T150 tissue culture flask.

Highly viable (>95%) Jurkat T cells were harvested and plated out in acomplete growth media at 2×10⁵ cells/2004, per well in a round bottom96-well tissue culture plate. Cells were pre-treated with either mediumalone or a CD47-blocking antibody clone B6H12 at 12.5 μg/20 μL, per wellfor 1 hour at 37° C., 5% CO2. SIRPαFc fusion proteins or control Fcswere added at 3 μM final concentration in 20 μL/well and thepro-apoptotic agent staurosporine was used as a positive control wasadded at 1 μM in 20 μL/well. Untreated cells (UT) received 20 μL/wellmedia alone. Cells were incubated overnight at 37° C., 5% CO2. After anovernight incubation the cells were stained with Annexin-V:FITC/7-AADapoptosis detection kit from eBiosciences (Cat #88-8005-75) followingmanufacturer's instructions and analyzed by flow cytometry within 4hours of staining to prevent the progression of apoptosis.

As shown in FIG. 5, TTI-602, a three-domain fusion, induced a muchgreater level of Jurkat apoptosis than the single-domain fusion proteinsTTI-616 and TTI-620. The effect of TTI-602 was clearly CD47-specific, asit was neutralized by pre-treating the cells with B6H12, a CD47-blockingantibody. These results indicate that a single domain SIRPαFc fusionprotein is preferred over a three-domain SIRPαFc to minimize CD47agonist activity.

8. Erythrocyte Binding

One concern with CD47-based therapies is the expression of the target onthe surface of red blood cells (RBCs), which has the potential to act asa large antigen sink and cause hematological toxicity. Indeed, anemiahas been reported in animals treated with high affinity SIRPαFcsvariants and CD47-specific antibodies. The binding of SIRPαFc fusionproteins to human erythrocytes was therefore assessed by flow cytometry.Human RBCs were prepared using heparinized whole blood. Whole blood wascentrifuged at 200×g, room temperature for 10 minutes to remove theplatelets. After aspiration of the platelet fraction the tube was toppedup to the original volume with PBS, the content mixed well by invertingthe tube and the RBCs were pelleted by centrifugation at 1500 rpm for 5minutes. This wash was repeated 3-5 more times. After the final wash thesupernatant was aspirated and the tube was topped up with PBS up to theoriginal blood volume. RBCs were counted using haemocytometer andresuspended at 5×10⁸ cells/mL prior to RBC binding assay. The purity theerythrocytes was assessed by flow cytometry demonstrating anti-humanCD235a (eBiosciences Cat #12-9978).

It was observed that fusion proteins containing wild type SIRPαsequences bind very poorly to human erythrocytes, producing a signalthat is less than 2-fold above background even at high concentrations.In contrast, CD47 monoclonal antibodies typically bind at >100-foldabove background. The striking difference in RBC binding between SIRPαFcand CD47 antibodies is shown in FIG. 7A, which compares the binding ofTTI-616 to the CD47 antibody B6H12 over a range of concentrations. Todemonstrate that this phenomenon is not unique to B6H12, threeadditional CD47 antibodies (2D3, BRIC126 and CC2C6) were evaluated. Asshown in FIG. 7B, all four antibodies bound human RBCs at dramaticallyhigher levels than SIRPαFc. Note that SIRPαFc fusion proteins bindpoorly to human RBCs regardless of Fc isotype or one- or three-domainstructure (data not shown). Furthermore, the difference in erythrocytebinding between SIRPαFc and CD47 antibodies does not simply reflect adifference in CD47 affinity, as both classes of proteins bind similarlyto an AML tumor cell line (See FIG. 7C).

Several unexpected results were obtained from these studies. First, thesuperior binding affinity of single domain SIRPαFc compared to athree-domain SIRPαFc is not consistent with the published literature.Second, the strong role for the Fc region in the elimination of leukemiccells in vivo is inconsistent with data published by others, who haveargued that the efficacy of CD47 antibodies is due to blockade of theCD47− SIRPα interaction. As well, the superior in vivo efficacy ofTTI-621 (IgG1) would not be predicted based on the in vitro phagocytosisdata. Moreover, the very low binding of single domain SIRPαFc toerythrocytes, and the low CD47 agonist activity, all support the medicaluse of the SIRPαFc taught herein in preference to other CD47 inhibitors.

Collectively, these data indicate that an optimal human SIRPαFc fusionprotein should contain a single (N-terminal) SIRPα domain linked to aneffector competent Fc region, such as the Fc region of a human IgG1preferably, or the Fc region of a human IgG4 suitably.

APPENDIX 1 Sequence Listings Summary

Sequence ID Type Sequence origin 1 amino acid SIRPα V2 version IgVregion 2 amino acid Fc region of human IgG1 sequence based on P01857 3amino acid complete sequence of mature SIRPαFc 4 amino acid completesequence of secretable SIRPαFc 5 DNA coding sequence for IgV-like regionof human SIRPα V2 version 6 DNA coding sequence for Fc region of humanIgG1 designated P01857 7 DNA coding sequence for mature SIRPαFc 8 DNAcoding sequence for secretable SIRPαFc 9 DNA primer used in SIRPαFc geneconstruction 10 DNA primer used in SIRPαFc gene construction 11 DNAprimer used in SIRPαFc gene construction 12 DNA primer used in SIRPαFcgene construction 13 DNA primer used in SIRPαFc gene construction 14 DNAprimer used in SIRPαFc gene construction 15 DNA primer used in SIRPαFcgene construction 16 DNA primer used in SIRPαFc gene construction 17 DNAprimer used in SIRPαFc gene construction 18 DNA primer used in SIRPαFcgene construction 19 DNA primer used in SIRPαFc gene construction 20 DNAprimer used in SIRPαFc gene construction 21 amino acid linker sequence22 amino acid human SIRPα V2 IgV domain 23 amino acid sequence ofwildtype IgG4 Fc 24 amino acid sequence of altered IgG4 Fc 25 amino acidsequence of IgG1-based SIRPαFc 26 amino acid sequence of IgG4-basedSIRPαFc 27 DNA coding sequence for SEQ ID No. 25 28 DNA coding sequencefor SEQ ID No. 26

SEQUENCE LISTING INFORMATION SIRPα V2 version IgV [SEQ ID No. 1]EELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGA IgG1 Fc region [SEQ ID No. 2]DKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK*Mature SIRPαG1 [SEQ ID No. 3]EEELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPSDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK* Secretable SIRPαG1 [SEQ ID No. 4]MEPAGPAPGRLGPLLCLLLAASCAWSGVAGEEELQVIQPDKSVSVAAGESAILHCTVTSLIPVGPIQWFRGAGPARELIYNQKEGHFPRVTTVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPSDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK*Coding sequence for Mature SIRPαG1 [SEQ ID No. 5]GAG GAG CTG CAG GTG ATT CAG CCT GAC AAG TCC GTA TCA GTT GCA GCT GGA GAG TCG GCC ATT CTG CAC TGCACT GTG ACC TCC CTG ATC CCT GTG GGG CCC ATC CAG TGG TTC AGA GGA GCT GGA CCA GCC CGG GAA TTA ATCTAC AAT CAA AAA GAA GGC CAC TTC CCC CGG GTA ACA ACT GTT TCA GAG TCC ACA AAG AGA GAA AAC ATG GACTTT TCC ATC AGC ATC AGT AAC ATC ACC CCA GCA GAT GCC GGC ACC TAC TAC TGT GTG AAG TTC CGG AAA GGGAGC CCT GAC ACG GAG TTT AAG TCT GGA GCACoding sequence for human IgG1 Fc region per se [SEQ ID No. 6]GAC AAA ACT CAC ACA TGC CCA CCG TGC CCA GCA CCT GAA CTC CTG GGG GGA CCG TCA GTC TTC CTC TTC CCACCA AAA CCC AAG GAC ACC CTC ATG ATC TCC CGG ACC CCT GAG GTC ACA TGC GTG GTG GTG GAC GTG AGC CACGAA GAC CCT GAG GTC AAG TTC AAC TGG TAC GTG GAC GGC GTG GAG GTG CAT AAT GCC AAG ACA AAG CCG CGGGAG GAG CAG TAC AAC AGC ACG TAC CGT GTG GTC AGC GTC CTC ACC GTC CTG CAC CAG GAC TGG CTG AAT GGCAAG GAG TAC AAG TGC AAG GTC TCC AAC AAA GCC CTC CCA GCC CCC ATC GAG AAA ACC ATC TCC AAA GCC AAAGGG CAG CCC CGA GAA CCA CAG GTG TAC ACC CTG CCC CCA TCC CGG GAT GAG CTG ACC AAG AAC CAG GTC AGCCTG ACC TGC CTG GTC AAA GGC TTC TAT CCC AGC GAC ATC GCC GTG GAG TGG GAG AGC AAT GGG CAG CCG GAGAAC AAC TAC AAG ACC ACG CCT CCC GTG CTG GAC TCC GAC GGC TCC TTC TTC CTC TAT AGC AAG CTC ACC GTGGAC AAG AGC AGG TGG CAG CAG GGG AAC GTC TTC TCA TGC TCC GTG ATG CAT GAG GCT CTG CAC AAC CAC TACACG CAG AAG AGC CTC TCC CTG TCT CCG GGT AAA TGACoding sequence for Mature SIRPαG1 [SEQ ID No. 7]GAG GAG CTG CAG GTG ATT CAG CCT GAC AAG TCC GTA TCA GTT GCA GCT GGA GAG TCG GCC ATT CTG CAC TGCACT GTG ACC TCC CTG ATC CCT GTG GGG CCC ATC CAG TGG TTC AGA GGA GCT GGA CCA GCC CGG GAA TTA ATCTAC AAT CAA AAA GAA GGC CAC TTC CCC CGG GTA ACA ACT GTT TCA GAG TCC ACA AAG AGA GAA AAC ATG GACTTT TCC ATC AGC ATC AGT AAC ATC ACC CCA GCA GAT GCC GGC ACC TAC TAC TGT GTG AAG TTC CGG AAA GGGAGC CCT GAC ACG GAG TTT AAG TCT GGA GCA GGC ACT GAG CTG TCT GTG CGT GCC AAA CCC TCT GAC AAA ACTCAC ACA TGC CCA CCG TGC CCA GCA CCT GAA CTC CTG GGG GGA CCG TCA GTC TTC CTC TTC CCA CCA AAA CCCAAG GAC ACC CTC ATG ATC TCC CGG ACC CCT GAG GTC ACA TGC GTG GTG GTG GAC GTG AGC CAC GAA GAC CCTGAG GTC AAG TTC AAC TGG TAC GTG GAC GGC GTG GAG GTG CAT AAT GCC AAG ACA AAG CCG CGG GAG GAG CAGTAC AAC AGC ACG TAC CGT GTG GTC AGC GTC CTC ACC GTC CTG CAC CAG GAC TGG CTG AAT GGC AAG GAG TACAAG TGC AAG GTC TCC AAC AAA GCC CTC CCA GCC CCC ATC GAG AAA ACC ATC TCC AAA GCC AAA GGG CAG CCCCGA GAA CCA CAG GTG TAC ACC CTG CCC CCA TCC CGG GAT GAG CTG ACC AAG AAC CAG GTC AGC CTG ACC TGCCTG GTC AAA GGC TTC TAT CCC AGC GAC ATC GCC GTG GAG TGG GAG AGC AAT GGG CAG CCG GAG AAC AAC TACAAG ACC ACG CCT CCC GTG CTG GAC TCC GAC GGC TCC TTC TTC CTC TAT AGC AAG CTC ACC GTG GAC AAG AGCAGG TGG CAG CAG GGG AAC GTC TTC TCA TGC TCC GTG ATG CAT GAG GCT CTG CAC AAC CAC TAC ACG CAG AAGAGC CTC TCC CTG TCT CCG GGT AAA TGACodingSequence for Secretable SIRPαG1 [SEQ ID No. 8]ATG GAG CCC GCC GGC CCG GCC CCC GGC CGC CTC GGG CCG CTG CTC TGC CTG CTG CTC GCC GCG TCC TGC GCCTGG TCA GGA GTG GCG GGT GAG GAG GAG CTG CAG GTG ATT CAG CCT GAC AAG TCC GTA TCA GTT GCA GCT GGAGAG TCG GCC ATT CTG CAC TGC ACT GTG ACC TCC CTG ATC CCT GTG GGG CCC ATC CAG TGG TTC AGA GGA GCTGGA CCA GCC CGG GAA TTA ATC TAC AAT CAA AAA GAA GGC CAC TTC CCC CGG GTA ACA ACT GTT TCA GAG TCCACA AAG AGA GAA AAC ATG GAC TTT TCC ATC AGC ATC AGT AAC ATC ACC CCA GCA GAT GCC GGC ACC TAC TACTGT GTG AAG TTC CGG AAA GGG AGC CCT GAC ACG GAG TTT AAG TCT GGA GCA GGC ACT GAG CTG TCT GTG CGTGCC AAA CCC TCT GAC AAA ACT CAC ACA TGC CCA CCG TGC CCA GCA CCT GAA CTC CTG GGG GGA CCG TCA GTCTTC CTC TTC CCA CCA AAA CCC AAG GAC ACC CTC ATG ATC TCC CGG ACC CCT GAG GTC ACA TGC GTG GTG GTGGAC GTG AGC CAC GAA GAC CCT GAG GTC AAG TTC AAC TGG TAC GTG GAC GGC GTG GAG GTG CAT AAT GCC AAGACA AAG CCG CGG GAG GAG CAG TAC AAC AGC ACG TAC CGT GTG GTC AGC GTC CTC ACC GTC CTG CAC CAG GACTGG CTG AAT GGC AAG GAG TAC AAG TGC AAG GTC TCC AAC AAA GCC CTC CCA GCC CCC ATC GAG AAA ACC ATCTCC AAA GCC AAA GGG CAG CCC CGA GAA CCA CAG GTG TAC ACC CTG CCC CCA TCC CGG GAT GAG CTG ACC AAGAAC CAG GTC AGC CTG ACC TGC CTG GTC AAA GGC TTC TAT CCC AGC GAC ATC GCC GTG GAG TGG GAG AGC AATGGG CAG CCG GAG AAC AAC TAC AAG ACC ACG CCT CCC GTG CTG GAC TCC GAC GGC TCC TTC TTC CTC TAT AGCAAG CTC ACC GTG GAC AAG AGC AGG TGG CAG CAG GGG AAC GTC TTC TCA TGC TCC GTG ATG CAT GAG GCT CTGCAC AAC CAC TAC ACG CAG AAG AGC CTC TCC CTG TCT CCG GGT AAA TGAPreferred SIRPα IgV domain [SEQ ID No. 22]EEELQVIQPDKSVSVAAGESAILHCTVISLIPVGPIONFRGAGPARELIYNQKEGHFPRVTIVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPS [SEQ ID No. 22]IgG4 sequence per se [SEQ ID No. 23]ESKYGPPCPSCPAPEFLGGPSVFLFPPKPKDILMISRTPEVICVVVDVSQEDPEVQFNTNYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVETNESNGQPENNYKTIPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK [SEQ ID No. 23] Altered IgG4 sequence per se[SEQ ID No. 24]ESKYGPPCPPCPAPEFLGGPSVFLFPPKPKDILMISRTPEVICVVVDVSQEDPEVQFNTNYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVETNESNGQPENNYKTIPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK[SEQ ID No. 24] SIRPαG1 [SEQ ID No. 25]EEELQVIQPDKSVSVAAGESAILHCTVISLIPVGPIONFRGAGPARELIYNQKEGHFPRVTIVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPSDKTHTCPPCPAPELLGGPSVFLFPPKPKDILMISRIPEVICVVVDVSHEDPEVKFNTNYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVETNESNGQPENNYKTIPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK [SEQ ID No. 25] SIRPαG4[SEQ ID No. 26]EEELQVIQPDKSVSVAAGESAILHCTVISLIPVGPIONFRGAGPARELIYNQKEGHFPRVTIVSESTKRENMDFSISISNITPADAGTYYCVKFRKGSPDTEFKSGAGTELSVRAKPSESKYGPPCPPCPAPEFLGGPSVFLFPPKPKDILMISRIPEVICVVVDVSQEDPEVQFNTNYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTIPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK [SEQ ID No. 26]Coding Sequence for secretable form of SIRPαG1 of SEQ ID No. 25[SEQ ID No. 27]ATG GAG CCC GCC GGC CCG GCC CCC GGC CGC CTC GGG CCG CTG CTC TGC CTG CTG CTC GCC GCG TCC TGC GCCTGG TCA GGA GTG GCG GGT GAG GAG GAG CTG CAG GTG ATT CAG CCT GAC AAG TCC GTA TCA GTT GCA GCT GGAGAG TCG GCC ATT CTG CAC TGC ACT GTG ACC TCC CTG ATC CCT GTG GGG CCC ATC CAG TGG TTC AGA GGA GCTGGA CCA GCC CGG GAA TTA ATC TAC AAT CAA AAA GAA GGC CAC TTC CCC CGG GTA ACA ACT GTT TCA GAG TCCACA AAG AGA GAA AAC ATG GAC TTT TCC ATC AGC ATC AGT AAC ATC ACC CCA GCA GAT GCC GGC ACC TAC TACTGT GTG AAG TTC CGG AAA GGG AGC CCT GAC ACG GAG TTT AAG TCT GGA GCA GGC ACT GAG CTG TCT GTG CGTGCC AAA CCC TCT GAC AAA ACT CAC ACA TGC CCA CCG TGC CCA GCA CCT GAA CTC CTG GGG GGA CCG TCA GTCTTC CTC TTC CCA CCA AAA CCC AAG GAC ACC CTC ATG ATC TCC CGG ACC CCT GAG GTC ACA TGC GTG GTG GTGGAC GTG AGC CAC GAA GAC CCT GAG GTC AAG TTC AAC TGG TAC GTG GAC GGC GTG GAG GTG CAT AAT GCC AAGACA AAG CCG CGG GAG GAG CAG TAC AAC AGC ACG TAC CGT GTG GTC AGC GTC CTC ACC GTC CTG CAC CAG GACTGG CTG AAT GGC AAG GAG TAC AAG TGC AAG GTC TCC AAC AAA GCC CTC CCA GCC CCC ATC GAG AAA ACC ATCTCC AAA GCC AAA GGG CAG CCC CGA GAA CCA CAG GTG TAC ACC CTG CCC CCA TCC CGG GAT GAG CTG ACC AAGAAC CAG GTC AGC CTG ACC TGC CTG GTC AAA GGC TTC TAT CCC AGC GAC ATC GCC GTG GAG TGG GAG AGC AATGGG CAG CCG GAG AAC AAC TAC AAG ACC ACG CCT CCC GTG CTG GAC TCC GAC GGC TCC TTC TTC CTC TAT AGCAAG CTC ACC GTG GAC AAG AGC AGG TGG CAG CAG GGG AAC GTC TTC TCA TGC TCC GTG ATG CAT GAG GCT CTGCAC AAC CAC TAC ACG CAG AAG AGC CTC TCC CTG TCT CCG GGT AAA TGACoding Sequence for secretable form of SIRPαG4 of SEQ ID No. 26[SEQ ID No. 28]ATG GAG CCC GCC GGC CCG GCC CCC GGC CGC CTC GGG CCG CTG CTC TGC CTG CTG CTC GCC GCG TCC TGC GCCTGG TCA GGA GTG GCG GGT GAG GAG GAG CTG CAG GTG ATT CAG CCT GAC AAG TCC GTA TCA GTT GCA GCT GGAGAG TCG GCC ATT CTG CAC TGC ACT GTG ACC TCC CTG ATC CCT GTG GGG CCC ATC CAG TGG TTC AGA GGA GCTGGA CCA GCC CGG GAA TTA ATC TAC AAT CAA AAA GAA GGC CAC TTC CCC CGG GTA ACA ACT GTT TCA GAG TCCACA AAG AGA GAA AAC ATG GAC TTT TCC ATC AGC ATC AGT AAC ATC ACC CCA GCA GAT GCC GGC ACC TAC TACTGT GTG AAG TTC CGG AAA GGG AGC CCT GAC ACG GAG TTT AAG TCT GGA GCA GGC ACT GAG CTG TCT GTG CGTGCC AAA CCC TCT GAG TCC AAA TAT GGT CCC CCA TGC CCA CCA TGC CCA GCA CCT GAG TTC CTG GGG GGA CCATCA GTC TTC CTG TTC CCC CCA AAA CCC AAG GAC ACT CTC ATG ATC TCC CGG ACC CCT GAG GTC ACG TGC GTGGTG GTG GAC GTG AGC CAG GAA GAC CCC GAG GTC CAG TTC AAC TGG TAC GTG GAT GGC GTG GAG GTG CAT AATGCC AAG ACA AAG CCG CGG GAG GAG CAG TTC AAC AGC ACG TAC CGT GTG GTC AGC GTC CTC ACC GTC CTG CACCAG GAC TGG CTG AAC GGC AAG GAG TAC AAG TGC AAG GTC TCC AAC AAA GGC CTC CCG TCC TCC ATC GAG AAAACC ATC TCC AAA GCC AAA GGG CAG CCC CGA GAG CCA CAG GTG TAC ACC CTG CCC CCA TCC CAG GAG GAG ATGACC AAG AAC CAG GTC AGC CTG ACC TGC CTG GTC AAG GGC TTC TAC CCC AGC GAC ATC GCC GTG GAG TGG GAGAGC AAT GGG CAG CCG GAG AAC AAC TAC AAG ACC ACG CCT CCC GTG CTG GAC TCC GAC GGC TCC TTC TTC CTCTAC AGC AGG CTA ACC GTG GAC AAG AGC AGG TGG CAG GAG GGG AAT GTC TTC TCA TGC TCC GTG ATG CAT GAGGCT CTG CAC AAC CAC TAC ACG CAG AAG AGC CTC TCC CTG TCT CTG GGT AAA TGA

Summary of regional components of SIRPαFc TTI-621 Amino Region FeatureNucleotides Acids SIRPα* Entire extracellular region  1-444  1-148 SIRPαsignal peptide 1-90  1-30 SIRPα IgV domain 94-411  32-137 Human IgG1Fc** Entire region 445-1125 149-375 Lower hinge region 445-465  149-155CH2 + CH3 domains 466-1125 156-375 *Human SIRPα sequence based onAAH26692. **Human IgG1 sequence based on P01857.

1-23. (canceled)
 24. A method of inhibiting growth or proliferation ofCD47+ disease cells comprising administering to a subject with CD47+disease cells a combination of an anti-cancer agent and a fusionprotein, said fusion protein (SIRPαFc) having a human SIRPα IgV domainfused to an immunoglobulin constant region polypeptide (Fc), wherein thehuman SIRPα IgV domain and the SIRPαFc fusion protein bind CD47.
 25. Themethod of claim 24, wherein the CD47+ disease cells are CD47+ cancercells.
 26. The method according to claim 25, wherein the disease cellsare CD47+ hematological cancer cells.
 27. The method according to claim26, wherein the CD47+ hematological cancer is a leukemia, a lymphoma, amultiple myeloma, or a myelodysplastic syndrome.
 28. The methodaccording to claim 27, wherein the CD47+ hematological cancer cell is anacute myeloid leukemia or a T cell lymphoma.
 29. The method according toclaim 25, wherein the cancer is a solid tumour comprising CD47+ cancercells.
 30. The method according to claim 25, wherein the CD47+ cancercells are melanoma cells.
 31. The method according to claim 24, whereinthe human SIRPα IgV domain comprises the SIRPα V2 IgV amino acidsequence of SEQ ID NO:
 1. 32. The method according to claim 31, whereinthe Fc component comprises an IgG1 Fc isotype or an IgG4 isotype. 33.The method according to claim 32, wherein the Fc component has up tofive amino acid substitutions.
 34. The method according to claim 33,wherein the Fc component comprises a substitution at position
 228. 35.The method according to claim 34, wherein the Fc component comprises aS228P substitution at position
 228. 36. The method according to claim33, having conservative substitutions at one or more sites selected from228, 234, 235, 236, 252, 256, and
 297. 37. The method according to claim32, wherein the Fc component comprises an IgG1 Fc isotype.
 38. Themethod according to claim 37, wherein the human SIRPαFc proteincomprises the amino acid sequence of SEQ ID NO:
 25. 39. The methodaccording to claim 32, wherein the human SIRPαFc protein comprises theamino acid sequence of SEQ ID NO:
 26. 40. The method according to claim24 that comprises administering a dimeric fusion protein having a firsthuman SIRPα IgV domain fused to an immunoglobulin constant regionpolypeptide (Fc) and a second fusion protein having a human SIRPα IgVdomain fused to an immunoglobulin constant region polypeptide (Fc),wherein the first and second fusions are liked through the Fc regions.41. The method according to claim 24, wherein the anti-cancer agentcomprises radiation or a radiotoxin or a cytotoxin.
 42. The methodaccording to claim 41, wherein the anti-cancer agent comprises thecytotoxin and the cytotoxin comprises taxol, ethidium bromide, emetine,mitomycin, etoposide, vincristine, vinblastine, colchicine, doxorubicin,daunorubicin, mitoxantrone, migramycin, or actinomycin D.
 43. The methodaccording to claim 41, wherein the anti-cancer agent is conjugated tothe SIRPαFc fusion protein.
 44. The method according to claim 24,wherein the anti-cancer agent comprises an antimetabolite, an alkylatingagent, an anthracycline, an antibiotic or an anti-mitotic agent.
 45. Themethod according to claim 44, wherein the anti-cancer agent comprisesmethotrexate, 6-mercaptopurine, 6-thioguanine, cytarabine,cyclophosphamide, busulfan, mitomycin C, cisplatin, dactinomycin,bleomycin, mithramycin, or anthramycin.
 46. The method according toclaim 24, wherein the anti-cancer agent comprises an anti-cancerantibody.
 47. A combination, in unit dosage form, containing ananti-cancer agent and a fusion protein, said fusion protein (SIRPαFc)having a human SIRPα IgV domain fused to an immunoglobulin constantregion polypeptide (Fc), wherein the human SIRPα IgV domain and theSIRPαFc fusion protein bind CD47.
 48. The combination according to claim47, wherein the anti-cancer agent comprises radiation or a radiotoxin ora cytotoxin.
 49. The combination according to claim 47, wherein theanti-cancer agent comprises an anti-cancer antibody.
 50. A method oftreating cancer comprising administering to a subject with cancer thecombination of claim
 47. 51. A composition containing an anti-canceragent and a fusion protein, said fusion protein (SIRPαFc) having a humanSIRPα IgV domain fused to an immunoglobulin constant region polypeptide(Fc), wherein the human SIRPα IgV domain and the SIRPαFc fusion proteinbind CD47.
 52. The composition according to claim 51, wherein theanti-cancer agent comprises an anti-cancer antibody.
 53. The compositionaccording to claim 51, wherein the anti-cancer agent is conjugated tothe SIRPαFc fusion protein.
 54. The composition according to claim 53,wherein the anti-cancer agent is a radiotoxin or a cytotoxin.
 55. Amethod of treating cancer comprising administering to a subject withcancer the composition of claim 51.